Teen Challenge International Pacific Northwest Centers

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

TEEN CHALLENGE INTERNATIONAL PACIFIC NORTHWEST CENTERS

Practice address

18600 SE McLoughlin Blvd
Milwaukie, OR 97267-6723

Phone

(971) 255-0658

NPI assigned

Aug 8, 2016

Organization subpart

No

Name

Brian NelsonNPI 1538516307

Title

Coo

Phone

(971) 255-0658

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brian Nelson, CADC I

  • Addiction (Substance Use Disorder) Counselor
  • Milwaukie, OR
  • NPI 1538516307
  NPD (past) Authorized official ADDICTION (SUBSTANCE USE DISORDER)
• Derek Ader, CADC-R

  • Addiction (Substance Use Disorder) Counselor
  • Shedd, OR
  • NPI 1437831526
  NPD ADDICTION (SUBSTANCE USE DISORDER)
• Cristin Anderson

  • Peer Specialist
  • Shedd, OR
  • NPI 1952126997
  NPD
• Adrian Bautista

  • Peer Specialist
  • Estacada, OR
  • NPI 1518734854
  NPD
• Travis Cook

  • Peer Specialist
  • Bend, OR
  • NPI 1497631329
  NPD
• Klodoaldo Cuevas

  • Peer Specialist
  • Estacada, OR
  • NPI 1700750718
  NPD
• Patricia Michelle Dexter

  • Peer Specialist
  • Milwaukie, OR
  • NPI 1659954683
  NPD
• Antonia Duran

  • Peer Specialist
  • Milwaukie, OR
  • NPI 1992511471
  NPD
• Lisa Farwell

  • Addiction (Substance Use Disorder) Counselor
  • Bend, OR
  • NPI 1982473849
  NPD ADDICTION (SUBSTANCE USE DISORDER)
• Ronda Fisk

  • Peer Specialist
  • Milwaukie, OR
  • NPI 1750279014
  NPD
• Violet Gott

  • Peer Specialist
  • Shedd, OR
  • NPI 1043196561
  NPD
• Gordon S Macmillan, CRM

  • Peer Specialist
  • Shedd, OR
  • NPI 1861273617
  NPD
• Taylor Markham, CRM

  • Peer Specialist
  • Shedd, OR
  • NPI 1962378497
  NPD
• James Miller

  • Peer Specialist
  • Estacada, OR
  • NPI 1538049564
  NPD
• Jared Robert Pettit

  • Addiction (Substance Use Disorder) Counselor
  • Estacada, OR
  • NPI 1407604374
  NPD ADDICTION (SUBSTANCE USE DISORDER)
• Rudy Rodriguez

  • Peer Specialist
  • Shedd, OR
  • NPI 1841014834
  NPD
• Kyra Ginee Rund

  • Peer Specialist
  • Shedd, OR
  • NPI 1184481087
  NPD
• Justin Rye

  • Addiction (Substance Use Disorder) Counselor
  • Estacada, OR
  • NPI 1386521359
  NPD ADDICTION (SUBSTANCE USE DISORDER)
• Stacey Seal, CADC 2

  • Addiction (Substance Use Disorder) Counselor
  • Milwaukie, OR
  • NPI 1417548470
  NPD ADDICTION (SUBSTANCE USE DISORDER)
• Jason Sommerfeldt

  • Addiction (Substance Use Disorder) Counselor
  • Shedd, OR
  • NPI 1013765015
  NPD ADDICTION (SUBSTANCE USE DISORDER)
• Gerold James Tinsley

  • Peer Specialist
  • Bend, OR
  • NPI 1861172652
  NPD
• Kendall Isaiah Turrentine, CADC-R

  • Addiction (Substance Use Disorder) Counselor
  • Milwaukie, OR
  • NPI 1184417610
  NPD ADDICTION (SUBSTANCE USE DISORDER)
• Teesa Twomoons, CRM

  • Peer Specialist
  • Estacada, OR
  • NPI 1609670967
  NPD
• Patricia Zink

  • Peer Specialist
  • Estacada, OR
  • NPI 1508726845
  NPD
• Erick Anderson

  • Addiction (Substance Use Disorder) Counselor
  • Renton, WA
  • NPI 1245910462
  NPD ADDICTION (SUBSTANCE USE DISORDER)

Locations

• Life Renewal - Portland Outpatient Doing business as
• Life Renewal - Shedd Outpatient Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 28, 2024.

{
    "created_epoch": "1470614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709078400000",
    "number": "1245784222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18600 SE MCLOUGHLIN BLVD",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972676723",
            "telephone_number": "971-255-0658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18600 SE MCLOUGHLIN BLVD",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972676723",
            "telephone_number": "971-255-0658"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3815 S 7th St W",
            "address_purpose": "LOCATION",
            "city": "Missoula",
            "state": "MT",
            "postal_code": "598041915",
            "country_code": "US",
            "telephone_number": "406-540-7001",
            "fax_number": "971-236-8080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5351 King Ave W",
            "address_purpose": "LOCATION",
            "city": "Billings",
            "state": "MT",
            "postal_code": "591062821",
            "country_code": "US",
            "telephone_number": "406-272-7220",
            "fax_number": "971-236-8080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "21115 92nd Ave E Ste A",
            "address_purpose": "LOCATION",
            "city": "Graham",
            "state": "WA",
            "postal_code": "983388088",
            "country_code": "US",
            "telephone_number": "253-846-0888",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18611 148th Ave SE",
            "address_purpose": "LOCATION",
            "city": "Renton",
            "state": "WA",
            "postal_code": "980589312",
            "country_code": "US",
            "telephone_number": "425-226-2608 x3380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "380 NW 6th Ave",
            "address_purpose": "LOCATION",
            "city": "Estacada",
            "state": "OR",
            "postal_code": "970237713",
            "country_code": "US",
            "telephone_number": "503-230-1910",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5040 SE 82nd Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972664802",
            "country_code": "US",
            "telephone_number": "503-395-0435",
            "fax_number": "971-236-8080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "31700 Fayetteville Dr",
            "address_purpose": "LOCATION",
            "city": "Shedd",
            "state": "OR",
            "postal_code": "973779779",
            "country_code": "US",
            "telephone_number": "541-491-1002 x11002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 N 20th Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Pasco",
            "state": "WA",
            "postal_code": "993013376",
            "country_code": "US",
            "telephone_number": "509-537-3025",
            "fax_number": "971-236-8080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2400 N Craig Rd",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992249568",
            "country_code": "US",
            "telephone_number": "509-606-6563",
            "fax_number": "971-236-8080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "545 S Knik Goose Bay Rd",
            "address_purpose": "LOCATION",
            "city": "Wasilla",
            "state": "AK",
            "postal_code": "996548171",
            "country_code": "US",
            "telephone_number": "907-268-4686",
            "fax_number": "971-236-8080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 NE Burnside Ave",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977015122",
            "country_code": "US",
            "telephone_number": "541-797-0098",
            "fax_number": "971-236-8080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "224 Martin St",
            "address_purpose": "LOCATION",
            "city": "Twin Falls",
            "state": "ID",
            "postal_code": "833014542",
            "country_code": "US",
            "telephone_number": "208-543-7230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEEN CHALLENGE INTERNATIONAL PACIFIC NORTHWEST CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-08",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "971-255-0658"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500711843",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90591",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1712386",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2173185",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Renewal - Portland Outpatient",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Life Renewal - Shedd Outpatient",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Judy Louise Taylor, OCCU THERAPIST AST
• Lori Ann Taylor, O.T.R.
• Peter Jack Taylor, D.O.
• Rachel Taylor, M.S., LPC
• Kathleen Marie Bell Tedlock, SPEECH LANGUAGE PATH
• Jenny Templeton
• Radu H Teodorescu, MD
• Cassandra Eleni Terhune
• Natasha Ternes
• Katrice Thabet-Chapin

• All providers in Milwaukie, OR
• Community/Behavioral Health Agency in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; 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.