Active NPI
Licci Jaimes, PSYD
- Clinical Psychologist
- McMinnville, OR
National Provider Identifier
1417473992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3095
- Practice address
- 115 NE May LN
McMinnville, OR 97128-9272 - Phone
- (503) 472-1338
- Fax
- (503) 434-8597
- NPI assigned
- Aug 16, 2017
- Last updated
- Jan 3, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3095 | OR | Primary |
Addresses
Primary practice location
115 NE May LN
McMinnville, OR 97128-9272
Mailing address
PO Box 6149
Aloha, OR 97007-0149
Phone (503) 352-8657
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3095 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578009600000",
"number": "1417473992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6149",
"city": "ALOHA",
"state": "OR",
"postal_code": "970070149",
"telephone_number": "503-352-8657",
"fax_number": "503-352-8658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 NE MAY LN",
"city": "MCMINNVILLE",
"state": "OR",
"postal_code": "971289272",
"telephone_number": "503-472-1338",
"fax_number": "503-434-8597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAIMES",
"first_name": "LICCI",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-16",
"last_updated": "2020-01-03",
"certification_date": "2020-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "3095",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McMinnville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.