Individual provider Active NPI

Heatherlin J Runnels, CRM, CADC-R

  • Addiction (Substance Use Disorder) Counselor
  • Portland, OR
National Provider Identifier
1306339031
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Practice address
709 NW Everett St
Portland, OR 97209-3517
Phone
(503) 209-5794
NPI assigned
Jun 7, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X 18-CRM-095 OR
Addiction (Substance Use Disorder) Counselor 101YA0400X Primary

Addresses

Primary practice location

709 NW Everett St
Portland, OR 97209-3517

Mailing address

1027 E Burnside St
Portland, OR 97214-1328
Phone (503) 239-8400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
18-CRM-095ORMDPeer Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Coda, Inc. CurrentSince Aug 28, 2021 Accepting new patients
Coda, Inc. Addiction (Substance Use Disorder) CurrentSince Aug 28, 2021 Accepting new patients
University Professional Services PastSince Aug 1, 2021 Accepting new patients
University Professional Services PastSince Aug 1, 2021 Accepting new patients

Locations

1027 E Burnside St
Portland, OR 97214

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1528329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1306339031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141328",
            "telephone_number": "503-239-8400",
            "fax_number": "971-271-8268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 NW EVERETT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093517",
            "telephone_number": "503-209-5794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNNELS",
        "first_name": "HEATHERLIN",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "CRM, CADC-R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-07",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "18-CRM-095",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "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 Dec 19, 2024; 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.