Active NPI
Timothy Gabriel Graham, PSS, CRM
- Peer Specialist
- Portland, OR
National Provider Identifier
1457160368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 101YM0800X
- Practice address
- 17440 NE Flanders St
Portland, OR 97230-6632 - Phone
- (760) 529-2076
- NPI assigned
- Jan 6, 2025
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 101YM0800X | OR | Primary |
Addresses
Primary practice location
17440 NE Flanders St
Portland, OR 97230-6632
Mailing address
8915 SW Center St
Tigard, OR 97223-6307
Phone (760) 726-3690
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 24-CRM-4000 | Other | OR | PSS CERTIFICATION (MHACBO) |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101YM0800X | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1736121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745193600000",
"number": "1457160368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8915 SW CENTER ST",
"city": "TIGARD",
"state": "OR",
"postal_code": "972236307",
"telephone_number": "760-726-3690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17440 NE FLANDERS ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972306632",
"telephone_number": "760-529-2076"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "TIMOTHY",
"middle_name": "GABRIEL",
"name_prefix": "Mr.",
"credential": "PSS, CRM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-01-06",
"last_updated": "2025-04-21",
"certification_date": "2025-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "101YM0800X",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSS CERTIFICATION (MHACBO)",
"identifier": "24-CRM-4000",
"state": "OR"
}
],
"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 Apr 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.