NPIMap

Organization Active NPI

Portland Dialectical Behavior Therapy PC

  • Cognitive & Behavioral Psychologist
  • Portland, OR
National Provider Identifier
1619913787
Registry record updated Jun 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
Legal business name
PORTLAND DIALECTICAL BEHAVIOR THERAPY PC
Practice address
5200 SW Macadam Ave
Ste 580
Portland, OR 97239
Phone
(503) 231-7854
Fax
(503) 231-8153
NPI assigned
Jun 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2008

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

Authorized official

Name
Amberly Martinson, BS
Title
Office Manager
Phone
(503) 231-7854

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TB0200X Primary

Addresses

Primary practice location

5200 SW Macadam Ave
Ste 580
Portland, OR 97239

Mailing address

5200 SW Macadam Ave
Ste 580
Portland, OR 97239
Phone (503) 231-7854

Other identifiers 1

IdentifierTypeStateIssuer
240095MedicaidOR

Other names 1

  • Portland DBT Program Other name

National Provider Directory

National Provider Directory

Locations

5125 S Macadam Ave
#145
Portland, OR 97239
Phone (503) 231-7854

5200 S Macadam Ave
Ste 580
Portland, OR 97239
Phone (503) 231-7854

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212624000000",
    "number": "1619913787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 SW MACADAM AVE",
            "address_2": "STE 580",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97239",
            "telephone_number": "503-231-7854",
            "fax_number": "503-231-8153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 SW MACADAM AVE",
            "address_2": "STE 580",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97239",
            "telephone_number": "503-231-7854",
            "fax_number": "503-231-8153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND DIALECTICAL BEHAVIOR THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2008-06-05",
        "status": "A",
        "authorized_official_last_name": "MARTINSON",
        "authorized_official_first_name": "AMBERLY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-231-7854",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240095",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portland DBT Program",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jun 5, 2008; 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.