Active NPI
Janice C. Premo
- Professional Counselor
- Portland, OR
National Provider Identifier
1518146802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2044
- Practice address
- 6400 SE Lake Rd Ste 102
Portland, OR 97222-2129 - Phone
- (503) 810-8111
- NPI assigned
- Nov 2, 2007
- Last updated
- Nov 4, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 07-09-36 | OR | |
| Professional Counselor | 101YP2500X | 2044 | OR | Primary |
| Professional Counselor | 101YP2500X | 85365 | OR |
Addresses
Primary practice location
6400 SE Lake Rd Ste 102
Portland, OR 97222-2129
Mailing address
6400 SE Lake Rd Ste 102
Portland, OR 97222-2129
Phone (503) 810-8111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07-09-36 | Other | OR | CADC1 |
Other names 1
- Jan Premo
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 |
|---|---|---|---|
| 85365 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194134400000",
"number": "1518146802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6400 SE LAKE RD STE 102",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972222129",
"telephone_number": "503-810-8111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6400 SE LAKE RD STE 102",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972222129",
"telephone_number": "503-810-8111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PREMO",
"first_name": "JANICE",
"middle_name": "C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-11-02",
"last_updated": "2007-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "07-09-36",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "2044",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "85365",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CADC1",
"identifier": "07-09-36",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JAN",
"last_name": "PREMO",
"credential": "MS, LPC, CADC1,CRC",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Portland, OR
- Premier Care Wellness Company (Premier Care Chiropractic)
- Premier Living Center Inc. (Premier Living Center)
- Premise Health of Oregon Medical P C (DTNA - Portland Occ)
- Premise Health of Oregon Medical P C (DTNA - Portland)
- Premise Health of Oregon Medical PC (Leatherman - Portland)
- Valerie A Premore, MBA, PMP, CCRP
- Raisa Premysler, MD
- Thomas Joseph Prendergast, M.D.
- William John Prendergast III, MD
- Susan M Preneta
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.