Revae L Hackett, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

11577 Finnegans Way
Oregon City, OR 97045-9770

Phone

(971) 252-5517

NPI assigned

Oct 28, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Clackamas County

  • Federally Qualified Health Center (FQHC)
  • Sandy, OR
  • NPI 1841442001
  NPD (past)
• County of Clackamas Office of County Auditor

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Milwaukie, OR
  • NPI 1245269315
  NPD (past)

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

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1558766923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11577 FINNEGANS WAY",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970459770",
            "telephone_number": "971-252-5517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11577 FINNEGANS WAY",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970459770",
            "telephone_number": "971-252-5517"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "38872 Proctor Blvd",
            "address_purpose": "LOCATION",
            "city": "Sandy",
            "state": "OR",
            "postal_code": "97055",
            "country_code": "US",
            "telephone_number": "503-722-6950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HACKETT",
        "first_name": "REVAE",
        "middle_name": "L",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-28",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OR",
            "license": "R4238",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C4820",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500678512",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bryan Ray Guthrie, DMD., P.C
• Norma Leticia Gutierrez, MSW, CSWA
• Tracy Emily Gutman, MD
• Desiree Guzman
• Robert C Haas, LCSW
• Danika Fawn Hakert
• Cara Danae Hall, RN
• Jonathan M Hall, DMD
• Kimberly Hall, RN
• Wendy S Hall, MD

• Mental Health Counselor in Oregon City, OR
• Providers in Oregon City, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.