Individual provider Active NPI

Andrea Lucio Rosales, MA

  • Mental Health Counselor
  • Hillsboro, OR
National Provider Identifier
1578945929
Registry record updated Nov 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
R6312 Issued in OR
Practice address
9620 NE Tanasbourne Dr Ste 300
Hillsboro, OR 97124-7844
Phone
(503) 207-5476
NPI assigned
Jun 22, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X R6312 OR Primary
Adult Companion 372600000X

Addresses

Primary practice location

9620 NE Tanasbourne Dr Ste 300
Hillsboro, OR 97124-7844

Mailing address

PO Box 8459
Portland, OR 97207-8459
Phone (503) 238-0769

Other practice location 1

847 NE 19th Ave
Suite 100
Portland, OR 97232-2684
Phone (503) 238-0769

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241210000194 OR Practitioner - Mental Health Counselor 8628504057 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifeline Medical CenterGroup PAC ID 3678948577, 22 clinicians

Practice addresses (Care Compare)

1915 NE Stucki Ave
Suite 400
Hillsboro, OR 97006-6938
Phone (844) 408-0014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
R6312ORMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Lifeline Medical Center Mental Health CurrentSince Nov 24, 2024 Accepting new patients

Locations

1915 NE Stucki Ave
Ste 400
Hillsboro, OR 97006
Phone (844) 408-0014

1925 NE Stucki Ave
Ste 150
Hillsboro, OR 97006

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20067/brand/1/csg/1/fhir/r4

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1434931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669161600000",
    "number": "1578945929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8459",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972078459",
            "telephone_number": "503-238-0769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9620 NE TANASBOURNE DR STE 300",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971247844",
            "telephone_number": "503-207-5476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "847 NE 19th Ave",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972322684",
            "country_code": "US",
            "telephone_number": "503-238-0769",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUCIO ROSALES",
        "first_name": "ANDREA",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-22",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "R6312",
            "primary": true
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hillsboro, OR

Sources for this page

Verify at the official NPI Registry.