Active NPI
Kristine Cavanaugh, LPC, CADC I
- Counselor
- Portland, OR
National Provider Identifier
1902013717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- C2116
- Practice address
- 1007 NE Broadway St Ste 220
Portland, OR 97232-1284 - Phone
- (503) 998-5727
- NPI assigned
- May 17, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | C2116 | OR | Primary |
Addresses
Primary practice location
1007 NE Broadway St Ste 220
Portland, OR 97232-1284
Mailing address
1007 NE Broadway St Ste 220
Portland, OR 97232-1284
Phone (503) 998-5727
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C2116 | Other | OR | OCLPCT |
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 |
|---|---|---|---|
| C2116 | OR | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458000000000",
"number": "1902013717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1007 NE BROADWAY ST STE 220",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321284",
"telephone_number": "503-998-5727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1007 NE BROADWAY ST STE 220",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321284",
"telephone_number": "503-998-5727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAVANAUGH",
"first_name": "KRISTINE",
"credential": "LPC, CADC I",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-17",
"last_updated": "2016-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OR",
"license": "C2116",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OCLPCT",
"identifier": "C2116",
"state": "OR"
}
],
"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 Mar 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.