Active NPI
Jessica Marie Atalla, CRC, LPC
- Professional Counselor
- Portland, OR
National Provider Identifier
1700627445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C6915
- Practice address
- 1020 SW Taylor St Ste 535
Portland, OR 97205-2527 - Phone
- (503) 841-7211
- NPI assigned
- Jun 5, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C6915 | OR | Primary |
Addresses
Primary practice location
1020 SW Taylor St Ste 535
Portland, OR 97205-2527
Mailing address
1020 SW Taylor St Ste 535
Portland, OR 97205-2527
Phone (503) 841-7211
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 |
|---|---|---|---|
| C6915 | OR | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hidden Vision LLC | Professional | Current | Accepting new patients |
Locations
1020 SW Taylor St
Ste 535
Portland, OR 97205
Phone (503) 827-4303
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719187200000",
"number": "1700627445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1020 SW TAYLOR ST STE 535",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052527",
"telephone_number": "503-841-7211",
"fax_number": "503-841-7211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1020 SW TAYLOR ST STE 535",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052527",
"telephone_number": "503-841-7211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ATALLA",
"first_name": "JESSICA",
"middle_name": "MARIE",
"credential": "CRC, LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-05",
"last_updated": "2024-06-24",
"certification_date": "2024-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C6915",
"primary": true
}
],
"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 Jun 24, 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.