Nicole H. Kennelly

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

6975 SW Sandburg St Ste 100
Tigard, OR 97223-8078

Phone

(971) 361-6834

NPI assigned

Jun 5, 2024

Last updated

Jul 16, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Weave Counseling, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tigard, OR
  • NPI 1760374888
  NPD Authorized official

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

{
    "created_epoch": "1717545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1841031440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8527 NW OGDEN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972311207",
            "telephone_number": "971-361-6834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6975 SW SANDBURG ST STE 100",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238078",
            "telephone_number": "971-361-6834"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10580 SW McDonald St",
            "address_purpose": "LOCATION",
            "city": "Tigard",
            "state": "OR",
            "postal_code": "972244867",
            "country_code": "US",
            "telephone_number": "971-242-4155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNELLY",
        "first_name": "NICOLE",
        "middle_name": "H.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-05",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mallory Alyse Kempton-Hein, PHARMD
• Ken R Erickson, M.D.
• Kathleen Kennedy, RN, IBCLC
• Shannon M Kennedy
• Tyler C Kennedy
• Johnny Keridwen
• Maura Kern Payne
• Dawn Julayne Kerns, LMT
• Kerri Smith, DMD, LLC (Tualatin Valley Dental)
• R. G. Evan Colbie Kerschner

• Mental Health Counselor in Tigard, OR
• Providers in Tigard, 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 16, 2025; 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.