Katherine L Wood

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

R8611 Issued in OR

Practice address

2808 NE Martin Luther King Blvd Ste M
Portland, OR 97212-3061

Phone

(971) 270-0535

Fax

(971) 369-9809

NPI assigned

Jun 26, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Katie Wood Other name

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 and National Provider Directory roles.

• Green Sheep Art Therapy LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, OR
  • NPI 1871373548
  NPD Authorized official
• Full Spectrum Therapy LLC

  • Counselor
  • Portland, OR
  • NPI 1568008001
  NPD (past)

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

{
    "created_epoch": "1656201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699315200000",
    "number": "1245962653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2808 NE MARTIN LUTHER KING BLVD STE M",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123061",
            "telephone_number": "971-270-0535",
            "fax_number": "971-369-9809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2808 NE MARTIN LUTHER KING BLVD STE M",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123061",
            "telephone_number": "971-270-0535",
            "fax_number": "971-369-9809"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1219 SE Lafayette St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972023802",
            "country_code": "US",
            "telephone_number": "503-765-5733",
            "fax_number": "971-244-8583",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOOD",
        "first_name": "KATHERINE",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-26",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "23-QMHP-R-2005",
            "primary": false
        },
        {
            "code": "221700000X",
            "taxonomy_group": "",
            "desc": "Art Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "R8611",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WA",
            "license": "MC61466384",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500820108",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "WOOD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Christopher Paul Wood, L.M.T.
• Donnella Eden Wood, MA
• Edwin Jon Wood, LMT
• Isabella Edith Wood
• Jamie Renee Wood
• Kenna Marie Wood, D.O.
• Kiana Wood
• Lena Soo Hee Wood, CNM
• Lily Kathleen Wood, MD
• Lisa Jo Wood

• Professional Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; 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.