Individual provider Active NPI

Cammi L Hubert, CADC II/CRM/PSS/QMHA

  • Addiction (Substance Use Disorder) Counselor
  • Portland, OR
National Provider Identifier
1952689846
Registry record updated Dec 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
14-04-17 Issued in OR
Practice address
17645 NW Saint Helens Rd
Portland, OR 97231-1729
Phone
(503) 621-1069
Fax
(503) 621-0200
NPI assigned
Jul 27, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 11-CRM-064 OR
Mental Health Counselor 101YM0800X 19-QMHA-I-01871 OR
Peer Specialist 175T00000X THW000002638 OR
Addiction (Substance Use Disorder) Counselor 101YA0400X 14-04-17 OR Primary

Addresses

Primary practice location

17645 NW Saint Helens Rd
Portland, OR 97231-1729

Mailing address

1776 SW Madison St
Portland, OR 97205-1715
Phone (503) 224-1044

Other practice location 1

900 Main St Ste 200
Oregon City, OR 97045-1869
Phone (503) 453-7879

Other identifiers 3

IdentifierTypeStateIssuer
500761226MedicaidOR
500737904MedicaidOR
500647496MedicaidOR

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

LicenseStateTypeSpecialty
11-CRM-064ORMDAddiction (Substance Use Disorder) Counselor
19-QMHA-I-01871ORMDMental Health Counselor
THW000002638ORMDPeer Specialist

NPI Registry JSON

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

{
    "created_epoch": "1311724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1952689846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 SW MADISON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051715",
            "telephone_number": "503-224-1044",
            "fax_number": "503-621-2235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17645 NW SAINT HELENS RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972311729",
            "telephone_number": "503-621-1069",
            "fax_number": "503-621-0200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Main St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Oregon City",
            "state": "OR",
            "postal_code": "970451869",
            "country_code": "US",
            "telephone_number": "503-453-7879",
            "fax_number": "503-723-6653",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUBERT",
        "first_name": "CAMMI",
        "middle_name": "L",
        "credential": "CADC II/CRM/PSS/QMHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-27",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "11-CRM-064",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "19-QMHA-I-01871",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "THW000002638",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "14-04-17",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500761226",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500737904",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500647496",
            "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 Dec 20, 2019; 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.