NPIMap

Organization Active NPI

Courageous Roots Institute

  • Clinical Psychologist
  • Portland, OR
National Provider Identifier
1992443402
Registry record updated Jun 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
COURAGEOUS ROOTS INSTITUTE
Practice address
1020 SW Taylor St Ste 855
Portland, OR 97205-2570
Phone
(503) 388-3433
NPI assigned
May 24, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2022

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

Authorized official

Name
Andrea Millen, PSYDNPI 1265866925
Title
Clinical Psychologist
Phone
(503) 388-3433

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

1020 SW Taylor St Ste 855
Portland, OR 97205-2570

Mailing address

1020 SW Taylor St Ste 855
Portland, OR 97205-2570
Phone (503) 388-3433

National Provider Directory

National Provider Directory

Locations

1020 SW Taylor St
Ste 855
Portland, OR 97205
Phone (503) 388-3433

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1653350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655683200000",
    "number": "1992443402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 SW TAYLOR ST STE 855",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052570",
            "telephone_number": "503-388-3433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 SW TAYLOR ST STE 855",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052570",
            "telephone_number": "503-388-3433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COURAGEOUS ROOTS INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-24",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A",
        "authorized_official_last_name": "MILLEN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "503-388-3433",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "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 Jun 20, 2022; 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.