NPIMap

Organization Active NPI

Reverie Psychotherapy LLC

  • Clinical Psychologist
  • Beaverton, OR
National Provider Identifier
1295453686
Registry record updated Aug 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
REVERIE PSYCHOTHERAPY LLC
Practice address
1500 NW Bethany Blvd Ste 200
Beaverton, OR 97006-5236
Phone
(503) 966-2395
NPI assigned
Aug 22, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2022

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

Authorized official

Name
Priscilla Shim, PSYDNPI 1902314578
Title
Owner and Sole Member
Phone
(503) 966-2395

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

1500 NW Bethany Blvd Ste 200
Beaverton, OR 97006-5236

Mailing address

1500 NW Bethany Blvd Ste 200
Beaverton, OR 97006-5236

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.

NPI Registry JSON

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

{
    "created_epoch": "1661126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661126400000",
    "number": "1295453686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 NW BETHANY BLVD STE 200",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970065236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 NW BETHANY BLVD STE 200",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970065236",
            "telephone_number": "503-966-2395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERIE PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-22",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-21",
        "status": "A",
        "authorized_official_last_name": "SHIM",
        "authorized_official_first_name": "PRISCILLA",
        "authorized_official_title_or_position": "OWNER AND SOLE MEMBER",
        "authorized_official_telephone_number": "503-966-2395",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; 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.