SAM DAVID GILLAM (NPI# 1083871743) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083871743 |
| Entity Type | Individual |
| Full Name | SAM DAVID GILLAM |
| Practice Address |
2410 Se 121st Ave Portland OR 97216-4066 |
| Mailing Address |
5815 Sw 59th Ct Portland OR 97221-1062 |
| Practice Telephone | 5033355975 |
| Mailing Telephone | 5033346205 |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2008-05-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| Street Address |
2410 SE 121ST AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97216-4066 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477621464 | Michelle Anne Fitz | Marriage & Family Therapist | 2410 Se 121st Ave, Suite 216, Portland, OR 97216-4066 | 2006-11-30 |
| 1790092559 | Tabitha Leeann Jenner | Counselor | 2410 Se 121st Ave, #216, Portland, OR 97216-4066 | 2010-09-01 |
| 1871819110 | Robert Taylor Ensign | Counselor | 2410 Se 121st Ave, Portland, OR 97216-4066 | 2010-04-12 |
| 1811139355 | Michele Rainier | Counselor | 2410 Se 121st Ave, #216, Portland, OR 97216-4066 | 2009-03-30 |
| 1992968341 | Chloe Vaughn | Counselor | 2410 Se 121st Ave, Suite 216, Portland, OR 97216-4066 | 2008-07-07 |
| 1316111404 | Laurie Louise Crandall-bass | Counselor | 2410 Se 121st Ave, #216, Portland, OR 97216-4066 | 2008-04-18 |
| 1245415298 | Jamie L. Stocker | Counselor | 2410 Se 121st Ave, Suite 216, Portland, OR 97216-4066 | 2008-01-08 |
| 1285815225 | Janelle L Jones | Counselor | 2410 Se 121st Ave, #216, Portland, OR 97216-4066 | 2007-11-19 |
| 1235254442 | Jasmine Phoung-hanh Nguyen | Counselor | 2410 Se 121st Ave, Suite 216, Portland, OR 97216-4066 | 2007-03-20 |
| 1558496299 | Christopher Jan Verschuyl | Social Worker | 2410 Se 121st Ave, Suite 216, Portland, OR 97216-4066 | 2007-02-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316468341 | Accident Care Chiropractic and Massage of Salem | Clinic/Center | 2168 Lancaster Dr. Ne, Portland, OR 97216 | 2017-06-29 |
| 1528508520 | Damone Brown | Peer Specialist | 10209 Se Washington St, Suite D, Portland, OR 97216 | 2017-02-24 |
| 1861937237 | Malachai Investments LLC | Clinical Medical Laboratory | 10,000 Se Main St, Ste 360, Portland, OR 97216 | 2016-12-21 |
| 1881136836 | Krista Marie Darnell | Occupational Therapy Assistant | 1475, Se 100th Avenue, Portland, OR 97216 | 2016-11-08 |
| 1821456559 | Sean Kelly | Counselor | 10564 Se Washington Street, Portland, OR 97216 | 2016-02-09 |
| 1174908321 | Phil Bergland | Counselor | 11220 Se Stark St, Suite 6, Portland, OR 97216 | 2015-07-29 |
| 1134507346 | Beth Lopez | Massage Therapist | 5814 Se Stark Street, Portland, OR 97216 | 2015-05-08 |
| 1982081477 | Amelia C Hunt | Counselor | 10564 Se Washinton Street, Portland, OR 97216 | 2015-05-04 |
| 1073907978 | Karen Ta | Emergency Medicine | 10300 Se Main St, Portland, OR 97216 | 2015-03-27 |
| 1265823298 | Laura Catherine Anderson | Occupational Therapist | 1475 Se 100th Avenue, Portland, OR 97216 | 2015-02-12 |
| Find all providers in zip 97216 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104427160 | Kristine Lee Jones | Counselor | 2628 Se 87th Ave, Portland, OR 97266-1530 | 2020-11-05 |
| 1932711322 | Rachel Wilson | Counselor | 1020 Se 7th Ave # 14283, Portland, OR 97214-2387 | 2020-08-18 |
| 1851919906 | Anjana Rajan | Counselor | Lifeworks Northwest, 14600 Nw Cornell Rd, Portland, OR 97229 | 2020-07-06 |
| 1972124196 | Outside In | Counselor | 16144 E Burnside St, Portland, OR 97233-3520 | 2020-04-28 |
| 1962022350 | Nicole Blake | Counselor | 400 Commercial St, Portland, ME 04101-4660 | 2020-04-25 |
| 1912527201 | Alexa Jenkins | Counselor | 2700 Se Stark St Apt 3, Portland, OR 97214-3499 | 2020-04-16 |
| 1467086629 | Katelan Ruby Hostetler | Counselor | 13300 Ne San Rafael St, Portland, OR 97230-3123 | 2020-02-26 |
| 1356973770 | Laura Kille | Counselor | Wise Counsel and Comfort, 2045 Se Hawthorne Blvd., Portland, OR 97214 | 2020-02-05 |
| 1093346777 | Sprout Therapy Pdx LLC | Counselor | 7704 N Hereford Ave, Portland, OR 97203-3434 | 2020-01-30 |
| 1861030553 | Steve Bijoga | Counselor | 1350 Forest Ave Apt 16, Portland, ME 04103-1815 | 2019-12-13 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.