Individual provider Active NPI

Daniel Jon Wardin, LPC, MAMFT, CADC I

  • Professional Counselor
  • Portland, OR
National Provider Identifier
1790831139
Registry record updated Sep 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
C2184 / ACTIVE LPC Issued in OR
Practice address
2415 SE 43Rd Ave
Portland, OR 97206-1600
Phone
(503) 238-0705
Fax
(503) 236-7166
NPI assigned
Jan 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2008

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X
Mental Health Counselor 101YM0800X
Professional Counselor 101YP2500X C2184 / ACTIVE LPC OR Primary

Addresses

Primary practice location

2415 SE 43Rd Ave
Portland, OR 97206-1600

Mailing address

20627 SW Jonquil Ter
Sherwood, OR 97140-8187
Phone (503) 925-8763

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241011001933 OR Practitioner - Mental Health Counselor 6204368541 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cascadia HealthGroup PAC ID 7618873761, 53 clinicians

Practice addresses (Care Compare)

4212 SE Division St
Suite 100
Portland, OR 97206-1680
Phone (503) 236-7166

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C2184 / ACTIVE LPCORMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Cascadia Health CurrentSince Sep 4, 2024 Accepting new patients
Cascadia Health CurrentSince Sep 4, 2024 Accepting new patients

Locations

4212 SE Division St
Ste 100
Portland, OR 97206
Phone (503) 238-0705

707 NW Everett St
Portland, OR 97209
Phone (503) 222-4906

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222128000000",
    "number": "1790831139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20627 SW JONQUIL TER",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "971408187",
            "telephone_number": "503-925-8763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 SE 43RD AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972061600",
            "telephone_number": "503-238-0705",
            "fax_number": "503-236-7166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARDIN",
        "first_name": "DANIEL",
        "middle_name": "JON",
        "name_prefix": "Mr.",
        "credential": "LPC, MAMFT, CADC I",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2008-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C2184 / ACTIVE LPC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.