Active NPI
Owls Nest North Therapy Joint
- Marriage & Family Therapist
- Portland, OR
National Provider Identifier
1376948232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- T0691
- Legal business name
- OWLS NEST NORTH THERAPY JOINT
- Practice address
- 3615 NE Grand Ave
Portland, OR 97212-2104 - Phone
- (503) 281-1166
- Fax
- (503) 281-0787
- NPI assigned
- Nov 4, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kristi Erlich, LMFT
- Title
- Owner
- Phone
- (503) 281-1166
Specialties & licenses 9
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Mental Health Counselor | 101YM0800X | |||
| Professional Counselor | 101YP2500X | |||
| Psychologist | 103T00000X | |||
| Clinical Psychologist | 103TC0700X | |||
| Social Worker | 104100000X | |||
| Clinical Social Worker | 1041C0700X | |||
| Marriage & Family Therapist | 106H00000X | T0691 | OR | Primary |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X |
Addresses
Primary practice location
3615 NE Grand Ave
Portland, OR 97212-2104
Mailing address
3615 NE Grand Ave
Portland, OR 97212-2104
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500643178 MCD | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240701000735 | OR | Part B Supplier - Clinic/Group Practice | 0840734943 |
Receives reassigned benefits from 11 practitioners Practice locations: Portland, OR |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 58
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Mental Health Counselor
- Lake Oswego, OR
- NPI 1952928293
Mental Health, OR
-
- Marriage & Family Therapist
- Portland, OR
- NPI 1740506716
-
- Marriage & Family Therapist
- Portland, OR
- NPI 1053869248
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415059200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1709683200000",
"number": "1376948232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3615 NE GRAND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972122104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3615 NE GRAND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972122104",
"telephone_number": "503-281-1166",
"fax_number": "503-281-0787"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OWLS NEST NORTH THERAPY JOINT",
"organizational_subpart": "NO",
"enumeration_date": "2014-11-04",
"last_updated": "2024-03-06",
"certification_date": "2024-03-06",
"status": "A",
"authorized_official_last_name": "ERLICH",
"authorized_official_first_name": "KRISTI",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "503-281-1166",
"authorized_official_credential": "LMFT"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "OR",
"license": "T0691",
"primary": true
},
{
"code": "363LP0808X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500643178 MCD",
"state": "OR"
}
],
"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 Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.