Frederick Douglass Staten, PH.D.,LPC, CADC III

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C4765 Issued in OR

Practice address

10920 SW Barbur Blvd
Portland, OR 97219-8600

Phone

(503) 244-4500

Fax

(503) 244-2008

NPI assigned

May 7, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2011

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Western Psychological and Counseling Services LLC

  • Clinical Psychologist
  • Tacoma, WA
  • NPI 1912008178

  Addiction (Substance Use Disorder), OR

  Medicare reassignment NPD
• Western Psychological and Counseling Services LLC

  • Clinical Psychologist
  • Vancouver, WA
  • NPI 1629345731
  NPD
• Cascadia Health

  • Primary Care Clinic/Center
  • Portland, OR
  • NPI 1144722935
  NPD (past)
• Serenity Lane

  • Substance Abuse Rehabilitation Facility
  • Coburg, OR
  • NPI 1104934892
  NPD (past)

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

{
    "created_epoch": "1336348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773360000000",
    "number": "1417216730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8459",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972078459",
            "telephone_number": "503-230-9654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10920 SW BARBUR BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972198600",
            "telephone_number": "503-244-4500",
            "fax_number": "503-244-2008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATEN",
        "first_name": "FREDERICK",
        "middle_name": "DOUGLASS",
        "credential": "PH.D.,LPC, CADC III",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-07",
        "last_updated": "2026-03-13",
        "certification_date": "2026-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WA",
            "license": "LH60296096",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C4765",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul M. Stasik, O.D.
• Emily Catherine Stasko, MPH, PHD
• Thomas Robert Stassen, PA-C
• Kamisia Staszewska, LPC
• Anna-Marie Ayala Stateler
• Brian Jacob Stater, M.D.
• Panagiota Stathopoulou, D.D.S., D.M.D.
• Seth Allen Statler
• Kate Statman-Weil, EDD, LCSW
• Anna Elizabeth Statz, MSW

• Professional Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.