Active NPI
Donald Jackson
- Counselor
- Portland, OR
National Provider Identifier
1609653179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- R8539
- Practice address
- 9138 NE Hoyt St
Portland, OR 97220-5868 - Phone
- (206) 249-6133
- NPI assigned
- Sep 11, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | R8539 | OR | Primary |
Addresses
Primary practice location
9138 NE Hoyt St
Portland, OR 97220-5868
Mailing address
9138 NE Hoyt St
Portland, OR 97220-5868
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 |
|---|---|---|---|
| R8539 | OR | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roots Foundational Counseling LLC | Counselor | Current | Accepting new patients |
| Kairospdx | Current | Accepting new patients |
Organizations & group practices 2
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.
-
- Mental Health Counselor
- Portland, OR
- NPI 1790507085
-
- Counselor
- Portland, OR
- NPI 1265207567
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695081600000",
"number": "1609653179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9138 NE HOYT ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972205868"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9138 NE HOYT ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972205868",
"telephone_number": "206-249-6133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DONALD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-09-11",
"last_updated": "2023-09-19",
"certification_date": "2023-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OR",
"license": "R8539",
"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 Sep 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.