Michelle Brooke Jolson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY33852 Issued in CA

Practice address

3710 SW US Veterans Hospital Rd
Portland, OR 97239-2964

Phone

(503) 220-8262

NPI assigned

Dec 9, 2022

Last updated

Dec 9, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1670544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670544000000",
    "number": "1780395780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2522 SE 32ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972021410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3710 SW US VETERANS HOSPITAL RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972392964",
            "telephone_number": "503-220-8262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLSON",
        "first_name": "MICHELLE",
        "middle_name": "BROOKE",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-09",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY33852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.va.gov/portland-health-care/",
            "affiliation": "N",
            "endpointDescription": "VA website",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "location",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "location",
            "address_1": "3710 SW US Veterans Hospital Rd",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972392964",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael David Jolliffe, LPC INTERN
• Katherine Marie Jolly, MA
• Trista L. Jolly, MAOM, L.AC.
• Celess Jollymore
• Heidi Jolson, MA LPC NCC CADC I
• Jon Fox, Ms, LPC
• Jona Group Homes LLC
• Brainna Wunderlin Jonak
• Jacob Stamp Jonas-Closs, BA
• Erik Clifford Jonas, RN, BSN

• Clinical Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; 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.