Active NPI
Gia J McKinzie, LCSW
- Mental Health Counselor
- Portland, OR
National Provider Identifier
1669904686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 5200 S Macadam Ave Ste 580
Portland, OR 97239-3837 - Phone
- (503) 231-7854
- Fax
- (503) 231-8153
- NPI assigned
- Mar 29, 2017
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Social Worker | 104100000X | LSW.0009921186 | CO | |
| Social Worker | 104100000X | L10719 | OR | |
| Mental Health Counselor | 101YM0800X | OR | Primary |
Addresses
Primary practice location
5200 S Macadam Ave Ste 580
Portland, OR 97239-3837
Mailing address
902 SE Spokane Avenue, Suite 324
Portland, OR 97202-3837
Phone (062) 307-2604
Other practice location 1
620 NE 2nd St
Gresham, OR 97030-7514
Phone (971) 274-3757
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500774015 | Medicaid | OR |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LSW.0009921186 | CO | MD | Social Worker |
| L10719 | OR | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663632000000",
"number": "1669904686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "902 SE SPOKANE AVENUE, SUITE 324",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972023837",
"telephone_number": "062-307-2604",
"fax_number": "719-301-5267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5200 S MACADAM AVE STE 580",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393837",
"telephone_number": "503-231-7854",
"fax_number": "503-231-8153"
}
],
"practiceLocations": [
{
"address_1": "620 NE 2nd St",
"address_purpose": "LOCATION",
"city": "Gresham",
"state": "OR",
"postal_code": "970307514",
"country_code": "US",
"telephone_number": "971-274-3757",
"fax_number": "503-912-5740",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MCKINZIE",
"first_name": "GIA",
"middle_name": "J",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-29",
"last_updated": "2022-09-20",
"certification_date": "2022-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CO",
"license": "LSW.0009921186",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OR",
"license": "L10719",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500774015",
"state": "OR"
}
],
"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 Sep 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.