Individual provider Active NPI

Amanda C Bossert, LPC

  • Professional Counselor
  • Portland, OR
National Provider Identifier
1447608393
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
C6268 Issued in OR
Practice address
9155 SW Barnes Rd Ste 205
Portland, OR 97225-6629
Phone
(503) 216-2025
NPI assigned
Jun 1, 2016
Last updated
Dec 5, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X C6268 OR Primary

Addresses

Primary practice location

9155 SW Barnes Rd Ste 205
Portland, OR 97225-6629

Mailing address

PO Box 3396
Portland, OR 97208-3396
Phone (503) 216-2380

Other names 1

  • Amanda C Bristow Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240102000599 OR Practitioner - Mental Health Counselor 7012367121 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C6268ORMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Jan 1, 2024 Accepting new patients
Providence Health & Services - Oregon CurrentSince Nov 11, 2025 Accepting new patients

Locations

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

5228 NE Hoyt St
Bldg B
Portland, OR 97213
Phone (503) 215-4860

9155 SW Barnes Rd
Ste 409
Portland, OR 97225
Phone (503) 216-1234

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1464739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1447608393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3396",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083396",
            "telephone_number": "503-216-2380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9155 SW BARNES RD STE 205",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256629",
            "telephone_number": "503-216-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSSERT",
        "first_name": "AMANDA",
        "middle_name": "C",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-01",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C6268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "BRISTOW",
            "middle_name": "C",
            "credential": "LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.