Individual provider Active NPI

Pamela Self

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1851742175
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L10482 Issued in OR
Practice address
2415 SE 43Rd Ave Ste 200
Portland, OR 97206-1671
Phone
(503) 238-0705
NPI assigned
Jun 28, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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 19-04-13 OR
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X L10482 OR Primary

Addresses

Primary practice location

2415 SE 43Rd Ave Ste 200
Portland, OR 97206-1671

Mailing address

PO Box 8459
Portland, OR 97207-8459

Other practice location 1

3036 NE Mlk Jr Blvd
Portland, OR 97212-3053
Phone (503) 889-2500

Other practice location 2

847 NE 19th Ave Ste 100
Portland, OR 97232-2684
Phone (503) 238-0769

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
I20210128002227 OR Practitioner - Clinical Social Worker 4284048422 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians

Practice addresses (Care Compare)

11740 SW 68TH Pkwy
Suite 200
Tigard, OR 97223-9058
Phone (971) 352-6984

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Cascadia Health Current Accepting new patients
Mindful Therapy Group PC Mental Health CurrentSince Sep 29, 2023 Accepting new patients
Cascadia Health CurrentSince Jan 15, 2021 Accepting new patients

Locations

1500 NE Irving St
Ste 210
Portland, OR 97232
Phone (425) 477-4215

5440 SW Westgate Dr
Ste 350
Portland, OR 97221
Phone (503) 292-1100

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

847 NE 19th Ave
Ste 100
Portland, OR 97232
Phone (503) 552-6203

3036 NE Mlk Jr Blvd
Portland, OR 97212
Phone (503) 283-3763

2415 SE 43rd Ave
Ste 200
Portland, OR 97206
Phone (503) 230-9654

11740 SW 68th Pkwy
Ste 200
Tigard, OR 97223
Phone (425) 477-4216

6505 216th St SW
Ste 100
Mountlake Terrace, WA 98043
Phone (425) 678-6463

Organizations & group practices 3

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": "1467072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1851742175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8459",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972078459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 SE 43RD AVE STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972061671",
            "telephone_number": "503-238-0705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3036 NE Mlk Jr Blvd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972123053",
            "country_code": "US",
            "telephone_number": "503-889-2500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "847 NE 19th Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972322684",
            "country_code": "US",
            "telephone_number": "503-238-0769",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SELF",
        "first_name": "PAMELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-28",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "19-04-13",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L10482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.