Chanel Breae Dismuke, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3292 Issued in OR

Practice address

1975 NW 167TH PL Ste 100-42
Beaverton, OR 97006-4908

Phone

(503) 436-5663

NPI assigned

Sep 24, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Honored Truth LLC

  • Clinical Psychologist
  • Beaverton, OR
  • NPI 1053278556

  Cognitive & Behavioral

  NPD Authorized official
• NW Intrinsic Psychotherapy

  • Clinical Psychologist
  • Beaverton, OR
  • NPI 1770369480

  Cognitive & Behavioral

  NPD

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

{
    "created_epoch": "1443052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720051200000",
    "number": "1780053314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1975 NW 167TH PL STE 100-42",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970064908",
            "telephone_number": "503-436-5663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 NW 167TH PL STE 100-42",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970064908",
            "telephone_number": "503-436-5663"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10700 SW Beaverton Hillsdale Hwy Ste 546",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970054739",
            "country_code": "US",
            "telephone_number": "503-436-5663",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DISMUKE",
        "first_name": "CHANEL",
        "middle_name": "BREAE",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-24",
        "last_updated": "2024-07-04",
        "certification_date": "2024-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "3292",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "3292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donnel T Dimond, PT
• Vincent Peter Dimone, L.P.C. , LMHC
• Paige G Dinsmore, LMT
• Dirkse Counseling and Consulting, Inc.
• Discover Chiropractic
• Divine Mercy Home Health, LLC.
• Erica Marie Divine, LPN
• Divinecarellc
• Gary V. Dixon, D.D.S.
• Mario Dixon

• Psychologist in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 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.

Verify at the official NPI Registry.