Active NPI
Nicole Kammerlocher
- Mental Health Counselor
- Lake Oswego, OR
National Provider Identifier
1730712688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 14523 Westlake Dr Ste 17
Lake Oswego, OR 97035-7700 - Phone
- (503) 941-0856
- NPI assigned
- Feb 19, 2020
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
14523 Westlake Dr Ste 17
Lake Oswego, OR 97035-7700
Mailing address
1417 SW 10TH Ave
Portland, OR 97201-3440
Phone (405) 412-9565
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | nicole@ccstpdx.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 17, 2025 through Mar 17, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582070400000",
"number": "1730712688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1417 SW 10TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972013440",
"telephone_number": "405-412-9565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14523 WESTLAKE DR STE 17",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970357700",
"telephone_number": "503-941-0856"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAMMERLOCHER",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-19",
"last_updated": "2020-02-19",
"certification_date": "2020-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "nicole@ccstpdx.com",
"affiliation": "N",
"address_1": "14523 Westlake Dr Ste 17",
"city": "Lake Oswego",
"state": "OR",
"country_code": "US",
"postal_code": "970357700",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lake Oswego, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.