Active NPI
Mark Gundry, L.P.C.
- Professional Counselor
- Portland, OR
National Provider Identifier
1710302005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C3340
- Practice address
- 511 SE 11TH Ave
Suite 204
Portland, OR 97214-2411 - Phone
- (503) 957-3391
- NPI assigned
- Feb 24, 2014
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C3340 | OR | Primary |
Addresses
Primary practice location
511 SE 11TH Ave
Suite 204
Portland, OR 97214-2411
Mailing address
511 SE 11TH Ave
Suite 204
Portland, OR 97214-2411
Phone (503) 957-3391
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 |
|---|---|---|---|
| C3340 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393200000000",
"number": "1710302005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "511 SE 11TH AVE",
"address_2": "SUITE 204",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972142411",
"telephone_number": "503-957-3391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "511 SE 11TH AVE",
"address_2": "SUITE 204",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972142411",
"telephone_number": "503-957-3391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUNDRY",
"first_name": "MARK",
"credential": "L.P.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-02-24",
"last_updated": "2014-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C3340",
"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 Feb 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.