Active NPI
Jay Michael Nelson, LMT, CADCI
- Addiction (Substance Use Disorder) Counselor
- Hillsboro, OR
National Provider Identifier
1720232499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 08-12-37
- Practice address
- 134 SE 5TH Ave Ste C
Hillsboro, OR 97123-4095 - Phone
- (503) 543-6100
- Fax
- (503) 214-8911
- NPI assigned
- Nov 7, 2008
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 8086 | OR | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 08-12-37 | OR | Primary |
Addresses
Primary practice location
134 SE 5TH Ave Ste C
Hillsboro, OR 97123-4095
Mailing address
134 SE 5TH Ave Ste C
Hillsboro, OR 97123-4095
Phone (503) 543-6100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 278095 | Medicaid | OR | |
| 1042985 | Other | OR | ASHNET - AMERICAN SPECIALTY HEALTH NETWORK |
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 |
|---|---|---|---|
| 8086 | OR | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inner Journey Healing Arts Center | Past | Accepting new patients |
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.
-
- Community/Behavioral Health Agency
- Hillsboro, OR
- NPI 1245684992
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678320000000",
"number": "1720232499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "134 SE 5TH AVE STE C",
"city": "HILLSBORO",
"state": "OR",
"postal_code": "971234095",
"telephone_number": "503-543-6100",
"fax_number": "503-648-5269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "134 SE 5TH AVE STE C",
"city": "HILLSBORO",
"state": "OR",
"postal_code": "971234095",
"telephone_number": "503-543-6100",
"fax_number": "503-214-8911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "JAY",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "LMT, CADCI",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-11-07",
"last_updated": "2023-03-09",
"certification_date": "2023-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OR",
"license": "8086",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "08-12-37",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "278095",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHNET - AMERICAN SPECIALTY HEALTH NETWORK",
"identifier": "1042985",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hillsboro, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.