Active NPI
Terressa Michelle Burbidge, BS
- Mental Health Counselor
- Portland, OR
National Provider Identifier
1417625294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 21-QMHA-R-1781
- Practice address
- 12121 E Burnside St
Portland, OR 97216-3737 - Phone
- (971) 361-7700
- NPI assigned
- Sep 5, 2021
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 21-QMHA-R-1781 | OR | Primary |
Addresses
Primary practice location
12121 E Burnside St
Portland, OR 97216-3737
Mailing address
232 NW 6TH Ave
Portland, OR 97209-3609
Phone (503) 294-1681
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)
- Not enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21-QMHA-R-1781 | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657238400000",
"number": "1417625294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "232 NW 6TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972093609",
"telephone_number": "503-294-1681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12121 E BURNSIDE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972163737",
"telephone_number": "971-361-7700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURBIDGE",
"first_name": "TERRESSA",
"middle_name": "MICHELLE",
"credential": "BS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-05",
"last_updated": "2022-07-08",
"certification_date": "2022-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "21-QMHA-R-1781",
"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 Jul 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.