Nicole Phelps, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L10373 Issued in OR

Practice address

1713 Penn LN
Oregon City, OR 97045-1528

Phone

(503) 655-7725

Fax

(503) 655-7720

NPI assigned

Aug 1, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 19, 2025 through Feb 19, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Connect Thrive Therapy, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lake Oswego, OR
  • NPI 1851042279
  NPD Authorized official
• Children'S Center

  • Child Abuse Pediatrics Physician
  • Oregon City, OR
  • NPI 1639349533
  NPD (past)

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

{
    "created_epoch": "1533081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1366920316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2044",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970350631",
            "telephone_number": "503-310-9405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1713 PENN LN",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970451528",
            "telephone_number": "503-655-7725",
            "fax_number": "503-655-7720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4800 Meadows Rd Ste 320",
            "address_purpose": "LOCATION",
            "city": "Lake Oswego",
            "state": "OR",
            "postal_code": "970354264",
            "country_code": "US",
            "telephone_number": "971-339-1662",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHELPS",
        "first_name": "NICOLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-01",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L10373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mara B Peterson, MD
• Shana K Peyser, MSW
• Maret Pfohman, PMHNP
• James Pham, PHARMD
• Khanh Mai Ngoc Pham, DMD
• Brittany Picardo
• Steven Andrew Pierson, P.T.
• Halee Love Pilcher
• Raleigh Scott Pioch, DDS
• Pioneer Dental Group PC

• Clinical Social Worker in Oregon City, OR
• Providers in Oregon City, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.