Clinton E Kittrell, MSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

L6482 Issued in OR

Practice address

46314 Timine Way
Pendleton, OR 97801-9099

Phone

(541) 966-9830

Fax

(541) 240-8410

NPI assigned

Jul 29, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Yellowhawk Tribal Health Center

  • Clinic/Center
  • Pendleton, OR
  • NPI 1346283488
  NPD
• Assured Imaging Womens Wellness of Washington, LLC

  • Diagnostic Radiology Physician
  • Tukwila, WA
  • NPI 1588982060
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1215345681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46314 TIMINE WAY",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978019099",
            "telephone_number": "541-966-9830",
            "fax_number": "541-240-8410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46314 TIMINE WAY",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978019099",
            "telephone_number": "541-966-9830",
            "fax_number": "541-240-8410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KITTRELL",
        "first_name": "CLINTON",
        "middle_name": "E",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-29",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "L6482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500681449",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Case H Ketting, MD
• Nora Kiggins, MA
• Lexus King
• Amity Lorraine Kirkland, D.P.M
• Miriam M Kirse, PA-C
• Jeffrey Alan Kobernik, D.M.D.
• Matthew Alan Kobzeff, CRM
• Natalie M. Kollross, PSY.D.
• Andrew John Koskenmaki, QMHA
• Levonne F Kountz, MSW, LCSW

• Mental Health Counselor in Pendleton, OR
• Providers in Pendleton, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.