Active NPI
David Gonzales, PHD
- Counseling Psychologist
- Portland, OR
National Provider Identifier
1679827356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- C1066
- Practice address
- 3181 SW Sam Jackson Park Rd
CR 115
Portland, OR 97239-3011 - Phone
- (503) 494-1660
- Fax
- (503) 494-5407
- NPI assigned
- Nov 2, 2012
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C1066 | OR | |
| Counseling Psychologist | 103TC1900X | C1066 | OR | Primary |
Addresses
Primary practice location
3181 SW Sam Jackson Park Rd
CR 115
Portland, OR 97239-3011
Mailing address
3181 SW Sam Jackson Park Rd
CR 115
Portland, OR 97239-3011
Phone (503) 494-1660
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C1066 | Other | OR | STATE OF OREGON BOARD OF LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS |
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 |
|---|---|---|---|
| C1066 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351814400000",
"number": "1679827356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3181 SW SAM JACKSON PARK RD",
"address_2": "CR 115",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393011",
"telephone_number": "503-494-1660",
"fax_number": "503-494-5407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3181 SW SAM JACKSON PARK RD",
"address_2": "CR 115",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393011",
"telephone_number": "503-494-1660",
"fax_number": "503-494-5407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALES",
"first_name": "DAVID",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-11-02",
"last_updated": "2012-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C1066",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "OR",
"license": "C1066",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF OREGON BOARD OF LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS",
"identifier": "C1066",
"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 Nov 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.