Active NPI
Callie Holgate
- Marriage & Family Therapist
- Portland, OR
National Provider Identifier
1487399069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- R10618
- Practice address
- 12636 SE Stark St BLDG J
Portland, OR 97233-1058 - Phone
- (503) 253-4600
- NPI assigned
- Apr 28, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 25-QMHP-R-3348 | OR | |
| Marriage & Family Therapist | 106H00000X | R10618 | OR | Primary |
Addresses
Primary practice location
12636 SE Stark St BLDG J
Portland, OR 97233-1058
Mailing address
12636 SE Stark St BLDG J
Portland, OR 97233-1058
Phone (503) 253-4600
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 |
|---|---|---|---|
| 25-QMHP-R-3348 | OR | MD | Mental Health Counselor |
| R10618 | OR | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738108800000",
"number": "1487399069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12636 SE STARK ST BLDG J",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972331058",
"telephone_number": "503-253-4600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12636 SE STARK ST BLDG J",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972331058",
"telephone_number": "503-253-4600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLGATE",
"first_name": "CALLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-28",
"last_updated": "2025-01-29",
"certification_date": "2025-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "25-QMHP-R-3348",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "OR",
"license": "R10618",
"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 Jan 29, 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.