Active NPI
Traci Goodrich, REGISTERED ASSOCIATE
- Marriage & Family Therapist
- Gladstone, OR
National Provider Identifier
1730921297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- R9311
- Practice address
- Lifestance Health
880 82ND Drive
Gladstone, OR 97027 - Phone
- (503) 659-5515
- NPI assigned
- Jun 6, 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | R9311 | OR | Primary |
Addresses
Primary practice location
Lifestance Health
880 82ND Drive
Gladstone, OR 97027
Mailing address
15315 SE Lee Ave
Milwaukie, OR 97267-2639
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 |
|---|---|---|---|
| R9311 | OR | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727308800000",
"number": "1730921297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15315 SE LEE AVE",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972672639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "LIFESTANCE HEALTH",
"address_2": "880 82ND DRIVE",
"city": "GLADSTONE",
"state": "OR",
"postal_code": "97027",
"telephone_number": "503-659-5515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODRICH",
"first_name": "TRACI",
"credential": "REGISTERED ASSOCIATE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-06",
"last_updated": "2024-09-26",
"certification_date": "2024-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "OR",
"license": "R9311",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gladstone, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.