Active NPI
Ali Fares
- Behavior Technician
- Portland, OR
National Provider Identifier
1386498202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 10714 NE Glisan St
Portland, OR 97220-4046 - Phone
- (503) 256-2453
- NPI assigned
- Apr 16, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
10714 NE Glisan St
Portland, OR 97220-4046
Mailing address
11547 SW 64TH Ave
Portland, OR 97219-7099
Phone (773) 757-4115
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifeworks NW | Current | Accepting new patients |
Locations
10714 NE Glisan St
Portland, OR 97220
Phone (503) 254-2453
Organizations & group practices 1
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.
-
- Mental Health Counselor
- Portland, OR
- NPI 1467408013
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713398400000",
"number": "1386498202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11547 SW 64TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972197099",
"telephone_number": "773-757-4115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10714 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972204046",
"telephone_number": "503-256-2453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARES",
"first_name": "ALI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-16",
"last_updated": "2024-04-18",
"certification_date": "2024-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"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 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.