Active NPI
Stephanie Chytalo
- Mental Health Counselor
- Portland, OR
National Provider Identifier
1518687938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- A13606
- Practice address
- 12121 E Burnside St
Portland, OR 97216-3737 - Phone
- (971) 361-7700
- NPI assigned
- Aug 29, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | A13606 | OR | Primary |
Addresses
Primary practice location
12121 E Burnside St
Portland, OR 97216-3737
Mailing address
232 NW 6TH Ave
Portland, OR 97209-3609
Phone (503) 294-1681
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240930002809 | OR | Order and Referring Only - Clinical Social Worker | 9032640107 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A13606 | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661731200000",
"number": "1518687938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "232 NW 6TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972093609",
"telephone_number": "503-294-1681",
"fax_number": "503-294-4321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12121 E BURNSIDE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972163737",
"telephone_number": "971-361-7700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHYTALO",
"first_name": "STEPHANIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-29",
"last_updated": "2022-08-29",
"certification_date": "2022-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "A13606",
"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 Aug 29, 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.