Opal Institute LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

1639 Issued in OR

Legal business name

OPAL INSTITUTE LLC

Practice address

14780 SW Osprey Dr. #285
Beaverton, OR 97007

Phone

(503) 308-4251

Fax

(503) 591-8628

NPI assigned

Dec 17, 2010

Last updated

Apr 17, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amy Susan Schultz, PH.D

Title

Owner

Phone

(503) 308-4251

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amy Susan Friday, PH.D.

  • Clinical Neuropsychologist
  • Beaverton, OR
  • NPI 1013084300
  Medicare reassignment Care Compare group NPD
• C Chyrelle Martin, PSY.D.

  • Forensic Psychologist
  • Portland, OR
  • NPI 1881921120
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1292544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366156800000",
    "number": "1639472319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14780 SW OSPREY DR. #285",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "97007",
            "telephone_number": "503-308-4251",
            "fax_number": "503-591-8628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14780 SW OSPREY DR. #285",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "97007",
            "telephone_number": "503-308-4251",
            "fax_number": "503-591-8628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPAL INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-17",
        "last_updated": "2013-04-17",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-308-4251",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "OR",
            "license": "1639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Clinical Neuropsychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.