Polly Gravely, M.S., LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C4602 Issued in OR

Practice address

5319 SW Westgate Dr Ste 246
Portland, OR 97221-2434

Phone

(503) 388-5710

NPI assigned

Feb 22, 2016

Sex

Female

Sole proprietor

Yes

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 Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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.

• Polly Gravely Counseling LLC

  • Community/Behavioral Health Agency
  • Portland, OR
  • NPI 1588297063

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1456099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1386003168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4028 SW 53RD PL",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212015",
            "telephone_number": "503-310-7472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5319 SW WESTGATE DR STE 246",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212434",
            "telephone_number": "503-388-5710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVELY",
        "first_name": "POLLY",
        "credential": "M.S., LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-22",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C4602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian Graulty, MD
• Oliver Winslow Graumann, DDS
• Carly Jane King Gravel
• Marie Nathalie France Gravel, D.C.
• Rory Kai Gravelle
• Megan Elisabeth Gravelyn, PA-C
• Carol Jean Graven, CADC1
• Tiffiny Jeannette Graven
• Amanda Jean Graves
• Christina Beatrice Graves

• Mental Health Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; 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.