Active NPI
Kelsey Kotsovos
- Counselor
- Portland, OR
National Provider Identifier
1639898943
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 1507 NE 122ND Ave
Portland, OR 97230-1911 - Phone
- (503) 258-4555
- NPI assigned
- Aug 22, 2022
- Sex
- Female
- Sole proprietor
- No
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 | Primary |
Addresses
Primary practice location
1507 NE 122ND Ave
Portland, OR 97230-1911
Mailing address
1507 NE 122ND Ave
Portland, OR 97230-1911
Phone (503) 258-4555
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 3, 2025 through Nov 3, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661126400000",
"number": "1639898943",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1507 NE 122ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972301911",
"telephone_number": "503-258-4555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1507 NE 122ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972301911",
"telephone_number": "503-258-4555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOTSOVOS",
"first_name": "KELSEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-22",
"last_updated": "2022-08-22",
"certification_date": "2022-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"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 Aug 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.