Heidi Bermeosolo, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C3069 Issued in OR

Practice address

1700 NW Civic Dr Ste 310
Gresham, OR 97030-3774

Phone

(503) 666-8832

Fax

(503) 666-8832

NPI assigned

Sep 16, 2009

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: lifestancehealth.heidibermeosolo@148835.advancedmd-direct.com

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

{
    "created_epoch": "1253059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1275866626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8007 NE 61ST ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986625467",
            "telephone_number": "503-349-1362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 NW CIVIC DR STE 310",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303774",
            "telephone_number": "503-666-8832",
            "fax_number": "503-666-8832"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10373 NE Hancock St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972203873",
            "country_code": "US",
            "telephone_number": "503-253-6754",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERMEOSOLO",
        "first_name": "HEIDI",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-16",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C3069",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ramon Benton, MSW, CSWA
• Amy E Berg, PMHNP
• Daniel R Berger
• Robert W Bergstrom, MD
• Lily Bradenrose Berlstein, SLP
• Gabriel Tucker Bertell, PHARMD
• Mark Anthony Betsill, D.C
• Athena Marie Bettger, DMD
• Betty Transportation LLC
• Jenifer Bice, LCSW

• Mental Health Counselor in Gresham, OR
• Providers in Gresham, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.