Individual provider Active NPI

Ann Kellett Reeves, M.S, LPC, CADC-1

  • Mental Health Counselor
  • Vancouver, WA
National Provider Identifier
1376732545
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
C2515 Issued in OR
Practice address
12607 SE Mill Plain Blvd
Vancouver, WA 98684-6055
Phone
(971) 413-8065
NPI assigned
Oct 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CADC 1- 10-06-34 OR
Mental Health Counselor 101YM0800X C2515 OR Primary

Addresses

Primary practice location

12607 SE Mill Plain Blvd
Vancouver, WA 98684-6055

Mailing address

12607 SE Mill Plain Blvd
Vancouver, WA 98684-6055
Phone (971) 413-8065

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240709004244 OR Practitioner - Mental Health Counselor 0840735304 Reassigns benefits to 1 organization
I20240807003340 WA Practitioner - Mental Health Counselor 0840735304 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
C2515ORMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Apr 21, 2024 Accepting new patients
Sapphire at Gresham Rehab, LLC CurrentSince May 21, 2024 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Apr 21, 2024 Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

3550 N Interstate Ave
Portland, OR 97227
Phone (503) 285-9321

500 NE Multnomah St
Fl 11
Portland, OR 97232

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

12607 SE Mill Plain Blvd
Vancouver, WA 98684
Phone (360) 418-6001

14406 NE 20th Ave
Vancouver, WA 98686
Phone (360) 418-6001

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Organizations & group practices 3

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": "1193097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1376732545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12607 SE MILL PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846055",
            "telephone_number": "971-413-8065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12607 SE MILL PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846055",
            "telephone_number": "971-413-8065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REEVES",
        "first_name": "ANN",
        "middle_name": "KELLETT",
        "credential": "M.S, LPC, CADC-1",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-23",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "CADC 1- 10-06-34",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C2515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "12607 SE Mill Plain Blvd",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986846055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.