NPIMap

Organization Active NPI

Bridge City Counseling LLC

  • Professional Counselor
  • Portland, OR
National Provider Identifier
1407284953
Registry record updated Apr 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
C2381 Issued in OR
Legal business name
BRIDGE CITY COUNSELING LLC
Practice address
712 SE Hawthorne Blvd
Suite 100
Portland, OR 97214-3538
Phone
(503) 545-5329
Fax
(503) 327-8005
NPI assigned
Oct 19, 2013
Last updated
Apr 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2016

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

Authorized official

Name
Mr. Nathanael Bagley, LPC
Title
Owner
Phone
(503) 545-5329

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X C2381 OR Primary

Addresses

Primary practice location

712 SE Hawthorne Blvd
Suite 100
Portland, OR 97214-3538

Mailing address

712 SE Hawthorne Blvd
Suite 100
Portland, OR 97214-3538
Phone (503) 545-5329

Other identifiers 1

IdentifierTypeStateIssuer
500669729MedicaidOR

National Provider Directory

National Provider Directory

Locations

712 SE Hawthorne Blvd
Ste 100
Portland, OR 97214
Phone (503) 545-5329

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1382140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460505600000",
    "number": "1407284953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 SE HAWTHORNE BLVD",
            "address_2": "SUITE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972143538",
            "telephone_number": "503-545-5329",
            "fax_number": "503-327-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 SE HAWTHORNE BLVD",
            "address_2": "SUITE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972143538",
            "telephone_number": "503-545-5329",
            "fax_number": "503-327-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE CITY COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-19",
        "last_updated": "2016-04-13",
        "status": "A",
        "authorized_official_last_name": "BAGLEY",
        "authorized_official_first_name": "NATHANAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-545-5329",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C2381",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500669729",
            "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 Apr 13, 2016; 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.