NPIMap

Organization Active NPI

Integrative Trauma Treatment Center

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1295190247
Registry record updated Dec 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L4462 Issued in OR
Legal business name
INTEGRATIVE TRAUMA TREATMENT CENTER
Doing business as
Vancouver Integrative Counseling
Practice address
811 NW 19TH Ave Ste 102
Portland, OR 97209-1401
Phone
(971) 266-6910
Fax
(888) 972-3623
NPI assigned
Dec 17, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2015

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

Authorized official

Name
Athena Phillips, LCSW
Title
Owner
Phone
(971) 266-6910

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X L4462 OR Primary

Addresses

Primary practice location

811 NW 19TH Ave Ste 102
Portland, OR 97209-1401

Mailing address

811 NW 19TH Ave Ste 102
Portland, OR 97209-1401
Phone (971) 266-6910

Other names 1

  • Vancouver Integrative Counseling Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Integrative Trauma Treatment Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

811 NW 19th Ave
Ste 102
Portland, OR 97209
Phone 9712666910 ext. 302

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1450310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450310400000",
    "number": "1295190247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 NW 19TH AVE STE 102",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091401",
            "telephone_number": "971-266-6910",
            "fax_number": "888-972-3623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 NW 19TH AVE STE 102",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091401",
            "telephone_number": "971-266-6910",
            "fax_number": "888-972-3623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE TRAUMA TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-17",
        "last_updated": "2015-12-17",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "ATHENA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "971-266-6910",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L4462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vancouver Integrative Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 17, 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.