Individual provider Active NPI

Kimberly Wirth, LPC

  • Professional Counselor
  • Portland, OR
National Provider Identifier
1730831140
Registry record updated Jan 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
C7824 Issued in OR
Practice address
9135 SW Barnes Rd Ste 987
Portland, OR 97225-6646
Phone
(503) 216-2811
NPI assigned
Jan 26, 2022
Last updated
Jan 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X C7824 OR
Professional Counselor 101YP2500X C7824 OR Primary

Addresses

Primary practice location

9135 SW Barnes Rd Ste 987
Portland, OR 97225-6646

Mailing address

1215 SE Cora St
Portland, OR 97202-5024
Phone (951) 312-9373

Other names 1

  • Kimberly Smith Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240116004432 OR Practitioner - Mental Health Counselor 7911359831 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon Current Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon CurrentSince Jan 1, 2024 Accepting new patients
Providence Health & Services Oregon CurrentSince Jan 1, 2024 Accepting new patients
Providence Health & Services - Oregon CurrentSince Jan 1, 2024 Accepting new patients
Providence Health & Services - Oregon CurrentSince Jan 1, 2024 Accepting new patients
Providence Health & Services Oregon CurrentSince Jan 1, 2024 Accepting new patients
Providence Health & Services - Oregon CurrentSince Jan 1, 2024 Accepting new patients

Locations

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

5228 NE Hoyt St
Bldg B
Portland, OR 97213
Phone (503) 215-4860

9135 SW Barnes Rd
Ste 987
Portland, OR 97225
Phone (503) 216-2811

9155 SW Barnes Rd
Ste 409
Portland, OR 97225
Phone (503) 216-1234

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704240000000",
    "number": "1730831140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 SE CORA ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972025024",
            "telephone_number": "951-312-9373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9135 SW BARNES RD STE 987",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256646",
            "telephone_number": "503-216-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIRTH",
        "first_name": "KIMBERLY",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-26",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C7824",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C7824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "SMITH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.