Teen Challenge International Pacific Northwest Centers

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

TEEN CHALLENGE INTERNATIONAL PACIFIC NORTHWEST CENTERS

Doing business as

Life Renewal - Portland Outpatient
Life Renewal - Shedd Outpatient

Practice address

18600 SE McLoughlin Blvd
Milwaukie, OR 97267-6723

Phone

(971) 255-0658

NPI assigned

Aug 8, 2016

Last updated

Feb 28, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brian NelsonNPI 1538516307

Title

Coo

Phone

(971) 255-0658

Specialties & licenses 6

Addresses

Other names 2

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

Locations

Practitioners 62

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brian Nelson, CADC I

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

  • Addiction (Substance Use Disorder) Counselor
  • Shedd, OR
  • NPI 1437831526
  NPD
• 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
• 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

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

{
    "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": [],
    "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

• Community/Behavioral Health Agency in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• 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.