Philip C Reisberg

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C3561 Issued in OR

Practice address

12 SE 14TH Ave.
Suite 206
Portland, OR 97214

Phone

(503) 267-8040

NPI assigned

Oct 22, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mentored Learning Professional name

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1831593649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 SE 14TH AVE.",
            "address_2": "SUITE 206",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97214",
            "telephone_number": "503-267-8040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 SE 14TH AVE.",
            "address_2": "SUITE 206",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97214",
            "telephone_number": "503-267-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REISBERG",
        "first_name": "PHILIP",
        "middle_name": "C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-22",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C3561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MENTORED",
            "last_name": "LEARNING",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Alexandra Morgan Reis, LCSW
• Maria Elena Reis, LMHC
• Marissa Reis
• Meghann Elizabeth Reis, PSY.D.
• Samantha Brianne Reis, BSN, RN
• Rebecca Anne Reisch, PT
• Kevin Charles Reiser
• Rachel A Reiser
• Lori Reising, LMT
• Joseph Reisman, LPC

• Professional Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.