Sport Psychology Institute Northwest

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

C1433 Issued in OR

Legal business name

SPORT PSYCHOLOGY INSTITUTE NORTHWEST

Practice address

833 SW 11TH Ave
Suite 925
Portland, OR 97205-2125

Phone

(866) 300-1515

NPI assigned

Aug 30, 2010

Organization subpart

No

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

Authorized official

Name

Mark Henry, MA

Title

President

Phone

(866) 300-1515

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1283126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283126400000",
    "number": "1457667206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 SW 11TH AVE",
            "address_2": "SUITE 925",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052125",
            "telephone_number": "866-300-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 SW 11TH AVE",
            "address_2": "SUITE 925",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052125",
            "telephone_number": "866-300-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORT PSYCHOLOGY INSTITUTE NORTHWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-30",
        "last_updated": "2010-08-30",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "866-300-1515",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OR",
            "license": "C1433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Elizabeth Spokes, PHD
• Mason D Spong, PA-C
• Patricia M Spooner, CNM
• Rachel Spooner
• Erika Nguyen Sporleder, CRNA
• Sportland Acupuncture LLC
• Sports Health Northwest Inc
• Sports Psychiatry Center LLC
• Sportscare Physical Therapy @ Cornell, LLC
• Samantha Joelle Sposito

• Community/Behavioral Health Agency in Portland, OR
• Providers in Portland, OR by specialty
• Community/Behavioral Health Agency in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2010; 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.