Jennifer Rose Portillo

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

116 SE D St Ste a
Madras, OR 97741-1699

Phone

(541) 904-5216

NPI assigned

Sep 13, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jennifer Rose Radford Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Brightways Counseling Group LLC

  • Group Psychotherapy Psychologist
  • Redmond, OR
  • NPI 1689191165
  NPD

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

{
    "created_epoch": "1568332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627430400000",
    "number": "1801446679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2229 NW IVY CT",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977568413",
            "telephone_number": "760-707-3532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 SE D ST STE A",
            "city": "MADRAS",
            "state": "OR",
            "postal_code": "977411699",
            "telephone_number": "541-904-5216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTILLO",
        "first_name": "JENNIFER",
        "middle_name": "ROSE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-13",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "RADFORD",
            "middle_name": "ROSE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicholas Pfaff
• Penne Sue Ellen Phifer, LMT
• Physician Management Services of Oregon, LLC
• Gary M Plant, MD
• Nicole Porter, ATC
• Karen V Potampa, NMNP-PP
• Shauna Queahpama, CRM
• Maribeth Quinn, CNM
• Ashanti Itzel Quintana
• Rachel Raburn

• Mental Health Counselor in Madras, OR
• Providers in Madras, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2021; 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.