Kimra K Roundy, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3166 Issued in OR

Practice address

13908 SE Stark St Ste a
Portland, OR 97233-2161

Phone

(503) 255-2343

Fax

(503) 255-2344

NPI assigned

Jul 30, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 9, 2023 through Mar 9, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Through the Looking Glass

  • Community/Behavioral Health Agency
  • Berkeley, CA
  • NPI 1528267028
  NPD (past)

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1518157072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13908 SE STARK ST STE A",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972332161",
            "telephone_number": "503-255-2343",
            "fax_number": "503-255-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13908 SE STARK ST STE A",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972332161",
            "telephone_number": "503-255-2343",
            "fax_number": "503-255-2344"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3075 Adeline St Ste 120",
            "address_purpose": "LOCATION",
            "city": "Berkeley",
            "state": "CA",
            "postal_code": "947032579",
            "country_code": "US",
            "telephone_number": "510-815-9505",
            "fax_number": "510-848-4445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROUNDY",
        "first_name": "KIMRA",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-30",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "RPS2012267",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "3166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Autumn L Roulan, LMT
• Julie Ann Rouleau
• Devon Corinne Roulette
• Thomas W Rounds
• Sarah Michelle Roundtree, PHD, CRC
• Jennifer Marie Rourke, APRN CNS
• Cortney Rouse
• Robert Wayne Rouse, LCSW
• Tia Rouse
• Callie Lynn Roush, LMT

• 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 Nov 13, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.