Active NPI
Justin Leak
- Marriage & Family Therapist
- Portland, OR
National Provider Identifier
1750571618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 0615 SW Palatine Hill Rd
MSC 101
Portland, OR 97219-7879 - Phone
- (503) 535-1181
- NPI assigned
- Jul 26, 2007
- Sex
- Male
- 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 | Primary |
Addresses
Primary practice location
0615 SW Palatine Hill Rd
MSC 101
Portland, OR 97219-7879
Mailing address
0615 SW Palatine Hill Rd
MSC 101
Portland, OR 97219-7879
Phone (503) 535-1181
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06396 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185408000000",
"number": "1750571618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "0615 SW PALATINE HILL RD",
"address_2": "MSC 101",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972197879",
"telephone_number": "503-535-1181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "0615 SW PALATINE HILL RD",
"address_2": "MSC 101",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972197879",
"telephone_number": "503-535-1181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEAK",
"first_name": "JUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-26",
"last_updated": "2007-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"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 Jul 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.