Individual provider Active NPI

Vanessa Martinez

  • Mental Health Counselor
  • Tigard, OR
National Provider Identifier
1922335793
Registry record updated Apr 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
C9563 Issued in OR
Practice address
11740 SW 68TH Pkwy Ste 200
Tigard, OR 97223-9058
Phone
(425) 477-4216
NPI assigned
Nov 15, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 180015368 IL
Mental Health Counselor 101YM0800X C9563 OR Primary

Addresses

Primary practice location

11740 SW 68TH Pkwy Ste 200
Tigard, OR 97223-9058

Mailing address

5441 S Macadam Ave Ste R
Portland, OR 97239-6106
Phone (847) 337-0492

Other practice location 1

2122 Claremont Ln
Lake IN The Hills, IL 60156-6405
Phone (847) 337-0492

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, OR2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240219003825 IL Practitioner - Mental Health Counselor 8426492315 Reassigns benefits to 1 organization
I20250416000490 OR Practitioner - Mental Health Counselor 8426492315 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2010
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

State licenses

LicenseStateTypeSpecialty
C9563ORMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Lifeline Medical Center Mental Health CurrentSince Jan 1, 2024 Accepting new patients
Mindful Therapy Group PC Mental Health CurrentSince Mar 29, 2025 Accepting new patients

Locations

1415 W 22nd St
Oak Brook, IL 60523
Phone (312) 806-3800

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

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

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20067/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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": "1258243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744329600000",
    "number": "1922335793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5441 S MACADAM AVE STE R",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972396106",
            "telephone_number": "847-337-0492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11740 SW 68TH PKWY STE 200",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972239058",
            "telephone_number": "425-477-4216"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2122 Claremont Ln",
            "address_purpose": "LOCATION",
            "city": "Lake IN The Hills",
            "state": "IL",
            "postal_code": "601566405",
            "country_code": "US",
            "telephone_number": "847-337-0492",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "VANESSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-15",
        "last_updated": "2025-04-11",
        "certification_date": "2025-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180015368",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C9563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

Verify at the official NPI Registry.