NPIMap

Organization Active NPI

Embodied Psychotherapy Inc

  • Clinical Psychologist
  • Portland, OR
National Provider Identifier
1376963652
Registry record updated Apr 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2135 Issued in OR
Legal business name
EMBODIED PSYCHOTHERAPY INC
Practice address
3050 SE Division St
Suite 210
Portland, OR 97202-1451
Phone
(503) 577-2842
NPI assigned
Apr 24, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2014

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

Authorized official

Name
Dr. William Banjo Weymouth, PSYDNPI 1124309877
Title
Clinical Psychologist
Phone
(503) 577-2842

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 2135 OR Primary

Addresses

Primary practice location

3050 SE Division St
Suite 210
Portland, OR 97202-1451

Mailing address

3050 SE Division St
Suite 210
Portland, OR 97202-1451
Phone (503) 577-2842

National Provider Directory

National Provider Directory

Locations

3050 SE Division St
Ste 210
Portland, OR 97202
Phone (503) 577-2842

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1398297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398297600000",
    "number": "1376963652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 SE DIVISION ST",
            "address_2": "SUITE 210",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972021451",
            "telephone_number": "503-577-2842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 SE DIVISION ST",
            "address_2": "SUITE 210",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972021451",
            "telephone_number": "503-577-2842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBODIED PSYCHOTHERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-24",
        "last_updated": "2014-04-24",
        "status": "A",
        "authorized_official_last_name": "WEYMOUTH",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "BANJO",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "503-577-2842",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "2135",
            "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 Apr 24, 2014; 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.