NPIMap

Organization Active NPI

Integrative Trauma Treatment Center, LLC

Doing business as Vancouver Integrative Counseling

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1417291212
Registry record updated Nov 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L4462 Issued in OR
Legal business name
INTEGRATIVE TRAUMA TREATMENT CENTER, LLC
Doing business as
Vancouver Integrative Counseling
Practice address
811 NW 19TH Ave Ste 102
Portland, OR 97209-1401
Phone
(971) 266-6910
Fax
(888) 972-3623
NPI assigned
Nov 16, 2012
Last updated
Nov 30, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
INTEGRATIVE TRAUMA TREATMENT CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 30, 2015

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

Authorized official

Name
Athena Phillips, LCSWNPI 1174859458
Title
Owner
Phone
(503) 819-4181

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X L4462 OR Primary

Addresses

Primary practice location

811 NW 19TH Ave Ste 102
Portland, OR 97209-1401

Mailing address

811 NW 19TH Ave Ste 102
Portland, OR 97209-1401
Phone (971) 266-6910

Other names 1

  • Vancouver Integrative Counseling Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Integrative Trauma Treatment Center2 organizations share this tax ID, including this one
Part of
Integrative Trauma Treatment Center

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

811 NW 19th Ave
Ste 102
Portland, OR 97209
Phone (971) 266-6910

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

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": "1353024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448841600000",
    "number": "1417291212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 NW 19TH AVE STE 102",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091401",
            "telephone_number": "971-266-6910",
            "fax_number": "888-972-3623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 NW 19TH AVE STE 102",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091401",
            "telephone_number": "971-266-6910",
            "fax_number": "888-972-3623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE TRAUMA TREATMENT CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTEGRATIVE TRAUMA TREATMENT CENTER",
        "enumeration_date": "2012-11-16",
        "last_updated": "2015-11-30",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "ATHENA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-819-4181",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L4462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vancouver Integrative Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 30, 2015; 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.