Active NPI
Anca Mirela Ivan, PSYD
- Clinical Psychologist
- West Linn, OR
National Provider Identifier
1669669784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 19910
- Practice address
- 1800 Blankenship Rd
# 200
West Linn, OR 97068-4172 - Phone
- (503) 650-2240
- Fax
- (503) 650-2248
- NPI assigned
- Oct 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 19910 | CA | Primary |
| Counseling Psychologist | 103TC1900X | PSY 19910 | CA |
Addresses
Primary practice location
1800 Blankenship Rd
# 200
West Linn, OR 97068-4172
Mailing address
1800 Blankenship Rd
# 200
West Linn, OR 97068-4172
Phone (503) 650-2240
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932 | Other | OR | LICENSE # |
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 |
|---|---|---|---|
| PSY 19910 | CA | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225238400000",
"number": "1669669784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 BLANKENSHIP RD",
"address_2": "# 200",
"city": "WEST LINN",
"state": "OR",
"postal_code": "970684172",
"telephone_number": "503-650-2240",
"fax_number": "503-650-2248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 BLANKENSHIP RD",
"address_2": "# 200",
"city": "WEST LINN",
"state": "OR",
"postal_code": "970684172",
"telephone_number": "503-650-2240",
"fax_number": "503-650-2248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVAN",
"first_name": "ANCA",
"middle_name": "MIRELA",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-02",
"last_updated": "2008-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 19910",
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "CA",
"license": "PSY 19910",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE #",
"identifier": "1932",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Linn, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.