Red Clover Wellness

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

RED CLOVER WELLNESS

Practice address

12525 SE Crest Way
Happy Valley, OR 97086

Phone

(503) 683-3627

NPI assigned

Oct 3, 2019

Organization subpart

No

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

Authorized official

Name

Katherine Reis, PMHNPNPI 1992050249

Title

Owner

Phone

(503) 683-3627

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Katherine Reis, NURSE PRACTITIONER

  • Psychiatry Physician
  • Happy Valley, OR
  • NPI 1992050249

  Single Specialty

  NPD Authorized official

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

{
    "created_epoch": "1570060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705363200000",
    "number": "1861033573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12042 SE SUNNYSIDE RD # 511",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970158382",
            "telephone_number": "503-683-3627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12525 SE CREST WAY",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "97086",
            "telephone_number": "503-683-3627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED CLOVER WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-03",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-12",
        "status": "A",
        "authorized_official_last_name": "REIS",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-683-3627",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "katy@redcloverwellness.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "7175 SW Beveland Rd Ste 105",
            "city": "Tigard",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972238665",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Vivian Lee Puga
• Ancuta Lavinia Radutiu, RN
• Akanksha Rajeurs, M.D.
• Rajesh Gade Rao, PA-C
• Jamie Anne Raskauskas, PTA,LMT
• Sebastian J Reeve, MD
• Katherine Reis, NURSE PRACTITIONER
• Nicholas Revilla
• Cindy Rho
• Emily Ann Ricard, DPT

• Psychiatry Physician in Happy Valley, OR
• Providers in Happy Valley, OR by specialty
• Psychiatry Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; 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.