NPIMap

Organization Active NPI

Imagine Life Counseling and Consultation, LLC.

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1407306913
Registry record updated Oct 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L4576 Issued in OR
Legal business name
IMAGINE LIFE COUNSELING AND CONSULTATION, LLC.
Practice address
2325 E Burnside St
Suite 202
Portland, OR 97214-1655
Phone
(503) 701-2294
NPI assigned
Oct 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2016

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

Authorized official

Name
Deah Renee Partak, LCSW, CADCII, ACSNPI 1376730986
Title
Owner / Therapist
Phone
(503) 701-2294

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X 11-06-94 OR
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X L4576 OR Primary

Addresses

Primary practice location

2325 E Burnside St
Suite 202
Portland, OR 97214-1655

Mailing address

2325 E Burnside St
Suite 202
Portland, OR 97214-1655
Phone (503) 701-2294

National Provider Directory

National Provider Directory

Locations

2325 E Burnside St
Ste 202
Portland, OR 97214
Phone (503) 701-2294

Practitioners & affiliated clinicians

Practitioners 1

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": "1475798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475798400000",
    "number": "1407306913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2325 E BURNSIDE ST",
            "address_2": "SUITE 202",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141655",
            "telephone_number": "503-701-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 E BURNSIDE ST",
            "address_2": "SUITE 202",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141655",
            "telephone_number": "503-701-2294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE LIFE COUNSELING AND CONSULTATION, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-07",
        "last_updated": "2016-10-07",
        "status": "A",
        "authorized_official_last_name": "PARTAK",
        "authorized_official_first_name": "DEAH",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "OWNER / THERAPIST",
        "authorized_official_telephone_number": "503-701-2294",
        "authorized_official_credential": "LCSW, CADCII, ACS"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "11-06-94",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L4576",
            "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 Oct 7, 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.