NPIMap

Organization Active NPI

Psychological Services Connection LLC

  • Psychologist
  • Portland, OR
National Provider Identifier
1275260465
Registry record updated Mar 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
PSYCHOLOGICAL SERVICES CONNECTION LLC
Practice address
811 SW 6TH Ave Ste 1000
Portland, OR 97204-1345
Phone
(503) 334-3035
Fax
(503) 961-9212
NPI assigned
Aug 7, 2022
Last updated
Mar 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2025

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

Authorized official

Name
Julie Keanaaina, MBA, LCSW, LICSWNPI 1780987511
Title
Owner
Phone
(503) 927-7724

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X NU
Psychologist 103T00000X NU Primary
Social Worker 104100000X NU
Marriage & Family Therapist 106H00000X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU

Addresses

Primary practice location

811 SW 6TH Ave Ste 1000
Portland, OR 97204-1345

Mailing address

811 SW 6TH Ave Ste 1000
Portland, OR 97204-1345
Phone (503) 334-3035

Other practice location 1

222 NW Davis St Ste 309
Portland, OR 97209-3900
Phone (503) 927-7724

Other names 2

  • Psychological Services Corporation Former legal business name
  • PSC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230718002835 OR Part B Supplier - Clinic/Group Practice 7416317789 Receives reassigned benefits from 27 practitioners
Practice locations: Portland, OR

National Provider Directory

National Provider Directory

Locations

222 NW Davis St
Ste 309
Portland, OR 97209
Phone (503) 334-3035

3611 SE 20th Ave
Ste 202
Portland, OR 97202
Phone (503) 334-3035

811 SW 6th Ave
Ste 1000
Portland, OR 97204
Phone (503) 334-3035

Practitioners & affiliated clinicians

Practitioners 32

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.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1659830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742428800000",
    "number": "1275260465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 SW 6TH AVE STE 1000",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972041345",
            "telephone_number": "503-334-3035",
            "fax_number": "503-961-9212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 SW 6TH AVE STE 1000",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972041345",
            "telephone_number": "503-334-3035",
            "fax_number": "503-961-9212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "222 NW Davis St Ste 309",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972093900",
            "country_code": "US",
            "telephone_number": "503-927-7724",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PSYCHOLOGICAL SERVICES CONNECTION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-07",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A",
        "authorized_official_last_name": "KEANAAINA",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-927-7724",
        "authorized_official_credential": "MBA, LCSW, LICSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Psychological Services Corporation",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "PSC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.