Collective Care Clinic, LLC

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

Legal business name

COLLECTIVE CARE CLINIC, LLC

Practice address

1130 SW Morrison St Ste 619
Portland, OR 97205-2217

Phone

(503) 313-0028

NPI assigned

Dec 2, 2019

Last updated

Dec 2, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jill Ashley Davidson, PSY.DNPI 1841508553

Title

Psychologist / Owner

Phone

(503) 313-0028

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jill Ashley Davidson, PSY.D

  • Clinical Psychologist
  • Portland, OR
  • NPI 1841508553
  NPD (past) Authorized official
• Annette Lynn Cantu, PHD

  • Clinical Psychologist
  • Portland, OR
  • NPI 1033798350
  NPD
• Amy Duede, PSY.D.

  • Clinical Psychologist
  • Urbandale, IA
  • NPI 1114470721
  NPD (past)

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

{
    "created_epoch": "1575244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575244800000",
    "number": "1780221499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 SW MORRISON ST STE 619",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052217",
            "telephone_number": "503-313-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 SW MORRISON ST STE 619",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052217",
            "telephone_number": "503-313-0028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLECTIVE CARE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-02",
        "last_updated": "2019-12-02",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "ASHLEY",
        "authorized_official_title_or_position": "PSYCHOLOGIST  / OWNER",
        "authorized_official_telephone_number": "503-313-0028",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cognitive & Behavioral Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Cognitive & Behavioral Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2019; 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.