Lisa Lynn Vesely

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

T20163 Issued in OR

Practice address

1122 NE 122ND Ave Ste A200
Portland, OR 97230-2083

Phone

(503) 594-4750

Fax

(971) 888-4607

NPI assigned

Oct 2, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sober Living Oregon Recovery Center

  dba Spark Wellness

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Oregon City, OR
  • NPI 1073081881
  NPD

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

{
    "created_epoch": "1601596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1225635287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1335 NW 23RD AVE APT 105",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102687",
            "telephone_number": "503-960-1025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 NE 122ND AVE STE A200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972302083",
            "telephone_number": "503-594-4750",
            "fax_number": "971-888-4607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VESELY",
        "first_name": "LISA",
        "middle_name": "LYNN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-02",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "T20163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Vervloet, USTAF
• John Vervynck
• Frances Ventura Verzosa, M.D.
• Karyn Verzwyvelt, LMT
• Abigail Vese, APRN
• Robin Katherine Vest
• Hannah Mary Vestal, M.A.
• Anne F Vestergaard, MD
• Veterans Administration Hospital
• Veterans Hospital

• Addiction (Substance Use Disorder) Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.