NPIMap

Organization Active NPI

Jordan Hendrickson, PSYD LLC

  • Mental Health Counselor
  • Portland, OR
National Provider Identifier
1295119089
Registry record updated Jul 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
2608 Issued in OR
Legal business name
JORDAN HENDRICKSON, PSYD LLC
Practice address
3310 SE Division St
Portland, OR 97202-1457
Phone
(503) 709-3295
NPI assigned
Jul 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2015

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

Authorized official

Name
Jordan Hendrickson, MDNPI 1437452018
Title
Owner
Phone
(503) 709-3295

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X 2608 OR Primary

Addresses

Primary practice location

3310 SE Division St
Portland, OR 97202-1457

Mailing address

3310 SE Division St
Portland, OR 97202-1457
Phone (503) 709-3295

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436745600000",
    "number": "1295119089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3310 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972021457",
            "telephone_number": "503-709-3295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3310 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972021457",
            "telephone_number": "503-709-3295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORDAN HENDRICKSON, PSYD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-13",
        "last_updated": "2015-07-13",
        "status": "A",
        "authorized_official_last_name": "HENDRICKSON",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-709-3295",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "2608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jul 13, 2015; 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.