Active NPI
Evergreen Counseling LLC
- Mental Health Counselor
- Portland, OR
National Provider Identifier
1649002387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Legal business name
- EVERGREEN COUNSELING LLC
- Practice address
- 937 NE Tillamook St
Portland, OR 97212-4059 - Phone
- (503) 334-9414
- Fax
- (844) 222-4353
- NPI assigned
- Aug 19, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Caitlin A Kiley, LPC
- Title
- Owner
- Phone
- (503) 334-9414
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
937 NE Tillamook St
Portland, OR 97212-4059
Mailing address
937 NE Tillamook St
Portland, OR 97212-4059
Phone (503) 334-9414
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C6961 | Other | OR | LPC |
| 500701824 | Medicaid | OR | |
| MHC.LH.60910450 | Other | WA | LMHC |
| 101YM0800X | Other | TAXONOMY CODE |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
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": "1724025600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1724025600000",
"number": "1649002387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "937 NE TILLAMOOK ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972124059",
"telephone_number": "503-334-9414",
"fax_number": "844-222-4353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "937 NE TILLAMOOK ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972124059",
"telephone_number": "503-334-9414",
"fax_number": "844-222-4353"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EVERGREEN COUNSELING LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-08-19",
"last_updated": "2024-08-19",
"certification_date": "2024-08-19",
"status": "A",
"authorized_official_last_name": "KILEY",
"authorized_official_first_name": "CAITLIN",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "503-334-9414",
"authorized_official_credential": "LPC"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LPC",
"identifier": "C6961",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500701824",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LMHC",
"identifier": "MHC.LH.60910450",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAXONOMY CODE",
"identifier": "101YM0800X",
"state": null
}
],
"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 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.