Active NPI
Dave R Gallison, LPC
- Professional Counselor
- Portland, OR
National Provider Identifier
1851764625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C0697
- Practice address
- 1509 SW Sunset Blvd Ste 2G
Portland, OR 97239-2690 - Phone
- (503) 704-7796
- NPI assigned
- Nov 2, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C0697 | OR | Primary |
Addresses
Primary practice location
1509 SW Sunset Blvd Ste 2G
Portland, OR 97239-2690
Mailing address
1431 SW Westwood Dr
Portland, OR 97239-2754
Phone (503) 452-2342
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 |
|---|---|---|---|
| C0697 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446422400000",
"number": "1851764625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1431 SW WESTWOOD DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972392754",
"telephone_number": "503-452-2342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1509 SW SUNSET BLVD STE 2G",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972392690",
"telephone_number": "503-704-7796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALLISON",
"first_name": "DAVE",
"middle_name": "R",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-11-02",
"last_updated": "2015-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C0697",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.