Active NPI
Caleb Burns, PH.D.
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1679607717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 743
- Practice address
- 2154 NE Broadway St
Suite 110
Portland, OR 97232-1561 - Phone
- (503) 288-4558
- Fax
- (503) 288-4558
- NPI assigned
- Mar 14, 2007
- Sex
- Male
- 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 | 743 | OR | Primary |
| Clinical Psychologist | 103TC0700X | 2803 | WA |
Addresses
Primary practice location
2154 NE Broadway St
Suite 110
Portland, OR 97232-1561
Mailing address
2154 NE Broadway St
Suite 110
Portland, OR 97232-1561
Phone (503) 288-4558
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2803 | WA | MD | Clinical Psychologist |
| 743 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679607717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2154 NE BROADWAY ST",
"address_2": "SUITE 110",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321561",
"telephone_number": "503-288-4558",
"fax_number": "503-288-4558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2154 NE BROADWAY ST",
"address_2": "SUITE 110",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321561",
"telephone_number": "503-288-4558",
"fax_number": "503-288-4558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURNS",
"first_name": "CALEB",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "743",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "2803",
"primary": false
}
],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.