Active NPI
John-Brian Wyckoff White, CRM, PSS, LMT
- Peer Specialist
- Hillsboro, OR
National Provider Identifier
1841956182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- THW000105572
- Practice address
- 971 SW Walnut St
Hillsboro, OR 97123-5651 - Phone
- (503) 640-5297
- NPI assigned
- Nov 10, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | THW000105572 | OR | Primary |
Addresses
Primary practice location
971 SW Walnut St
Hillsboro, OR 97123-5651
Mailing address
3872 Coho Cir
Forest Grove, OR 97116-3096
Phone (503) 313-0070
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| THW000105572 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636502400000",
"number": "1841956182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3872 COHO CIR",
"city": "FOREST GROVE",
"state": "OR",
"postal_code": "971163096",
"telephone_number": "503-313-0070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "971 SW WALNUT ST",
"city": "HILLSBORO",
"state": "OR",
"postal_code": "971235651",
"telephone_number": "503-640-5297"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "JOHN-BRIAN",
"middle_name": "WYCKOFF",
"credential": "CRM, PSS, LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-11-10",
"last_updated": "2021-11-10",
"certification_date": "2021-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "THW000105572",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hillsboro, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.