Leland St. Charles, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5872 Issued in MN

Practice address

2700 SE 26TH Ave Ste C
Portland, OR 97202-1288

Phone

(503) 755-8808

NPI assigned

Apr 11, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.lelandstcharles@148835.advancedmd-direct.com

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

• Leland St. Charles, Psychologist, LLC

  • Community/Behavioral Health Agency
  • Portland, OR
  • NPI 1427708171
  NPD Authorized official

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

{
    "created_epoch": "1460332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646524800000",
    "number": "1457715922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8415 SE 75TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972068613",
            "telephone_number": "503-755-8808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 SE 26TH AVE STE C",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972021288",
            "telephone_number": "503-755-8808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ST. CHARLES",
        "first_name": "LELAND",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-11",
        "last_updated": "2022-03-06",
        "certification_date": "2022-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "5872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St Mary Health LLC
• Krysta St Michell, MEDICAL STUDENT
• Kelsey Jordan St. Amand, PA-C, MPH
• St. Andrews Memory Care
• Jenna Lea St. Arnauld
• Amanda St. Clair
• Valerie Ann St. Clair
• Luke St. John
• Samuel St. John
• St. Johns Physical Therapy

• Clinical Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.