Active NPI
Gracie James Dilley-Bucciarelli
- Marriage & Family Therapist
- Portland, OR
National Provider Identifier
1508416546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- T2430
- Practice address
- 4036 NE Sandy Blvd Ste 203
Portland, OR 97212-5335 - Phone
- (503) 953-0957
- NPI assigned
- Sep 11, 2019
- 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 | |||
| Marriage & Family Therapist | 106H00000X | T2430 | OR | Primary |
Addresses
Primary practice location
4036 NE Sandy Blvd Ste 203
Portland, OR 97212-5335
Mailing address
4036 NE Sandy Blvd Ste 3
Portland, OR 97212-5335
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2024 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T2430 | OR | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701820800000",
"number": "1508416546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4036 NE SANDY BLVD STE 3",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972125335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4036 NE SANDY BLVD STE 203",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972125335",
"telephone_number": "503-953-0957"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DILLEY-BUCCIARELLI",
"first_name": "GRACIE",
"middle_name": "JAMES",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-11",
"last_updated": "2023-12-06",
"certification_date": "2023-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "OR",
"license": "T2430",
"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 Dec 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.