Individual provider Active NPI

Elizabeth Burdzy, QMHP-R

  • Mental Health Counselor
  • Portland, OR
National Provider Identifier
1376111062
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
24-QMHP-R-2549 Issued in OR
Practice address
1438 SE Division St
Portland, OR 97202-1140
Phone
(503) 548-0346
Fax
(503) 232-5959
NPI assigned
Jun 17, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 24-QMHP-R-2549 OR Primary
Counselor 101Y00000X MG61213616 WA

Addresses

Primary practice location

1438 SE Division St
Portland, OR 97202-1140

Mailing address

1776 SW Madison St
Portland, OR 97205-1715
Phone (503) 224-1044

Other identifiers 1

IdentifierTypeStateIssuer
500825220MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250204001543 WA Practitioner - Marriage and Family Therapist 2365972528 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sokyahealth Medical Group PCGroup PAC ID 9739575648, 68 clinicians

Practice addresses (Care Compare)

5109 NE 82ND Ave
Suite 215
Vancouver, WA 98662-6841
Phone (877) 840-6956

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MG61213616WAMDCounselor
24-QMHP-R-2549ORMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Sokyahealth Medical Group PC Counselor CurrentSince Jan 1, 2025 Accepting new patients
Shashita Inamdar MD Professional Corporation PastSince Jan 1, 2025 Accepting new patients

Locations

5109 NE 82nd Ave
Ste 215
Vancouver, WA 98662
Phone (832) 840-1604

Organizations & group practices 2

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": "1623888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1376111062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 SW MADISON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051715",
            "telephone_number": "503-224-1044",
            "fax_number": "503-621-2235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1438 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972021140",
            "telephone_number": "503-548-0346",
            "fax_number": "503-232-5959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURDZY",
        "first_name": "ELIZABETH",
        "credential": "QMHP-R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-17",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "24-QMHP-R-2549",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "MG61213616",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500825220",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.