SPROUT THERAPY PDX LLC (NPI# 1093346777) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093346777 |
| Entity Type | Organization |
| Organization Name | SPROUT THERAPY PDX LLC |
| Practice Address |
7704 N Hereford Ave Portland OR 97203-3434 |
| Mailing Address |
6012 N Villard Ave Portland OR 97217-4039 |
| Practice Telephone | 9713194827 |
| Practice Fax Number | 5036626220 |
| Mailing Telephone | 2068908045 |
| Mailing Fax Number | 5036626220 |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2020-01-30 |
| Authorized Official Name | EMELIE ANGELINA BLANK (OWNER & LEAD CLINICAN) |
| Authorized Official Telephone | 9713194827 |
| Authorized Official Credential | LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Sprout Therapy PDX | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | SPROUT THERAPY PDX LLC | 7704 N Hereford Ave, Portland, OR 97203 |
| Street Address |
7704 N HEREFORD AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97203-3434 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710592365 | Arlyne Soto | Counselor | 7704 N Hereford Ave, Portland, OR 97203-3434 | 2020-09-10 |
| 1750993051 | Monika Weitzel | Social Worker | 7704 N Hereford Ave, Portland, OR 97203-3434 | 2020-08-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952923757 | Justin Cummings | Meals | 10105 N. Oswego Ave, Portland, OR 97203 | 2020-05-14 |
| 1407335045 | Gage Solis | Student in an Organized Health Care Education/Training Program | 8425 N. Lombard St, Portland, OR 97203 | 2018-08-13 |
| 1497103493 | Ruby Diane Ciarlante | Community Health Worker | 7803 N Portsmouth Ave, Portland, OR 97203 | 2016-05-31 |
| 1992139620 | Hannah Clare | Speech-Language Pathologist | 7126 N Amherst St, Portland, OR 97203 | 2013-08-29 |
| 1043656713 | Heather Ranae Mcintosh | Social Worker | 7323 N Burlington Ave, Portland, OR 97203 | 2013-05-21 |
| 1275879363 | Matthew Scott Bennett | Pharmacist | 6850 N. Lombard, Portland, OR 97203 | 2012-12-18 |
| 1144594094 | Candice Juliet Thomas | Pharmacist | 9000 N. Lombard St, Portland, OR 97203 | 2012-02-23 |
| 1093013211 | Aarisa Elysianne Smith | Mechanotherapist | 8438 N Lombard St, Ste 7, Portland, OR 97203 | 2011-03-11 |
| 1700103546 | Lisa Catherine Davis | Acupuncturist | 1614 Ne Alberta Street, Portland, OR 97203 | 2010-05-03 |
| 1427298579 | Donald Marvin Lorenzen | Denturist | 8530 N. Ivanhoe, Portland, OR 97203 | 2009-03-03 |
| Find all providers in zip 97203 | ||||
| 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 |
| 1861030553 | Steve Bijoga | Counselor | 1350 Forest Ave Apt 16, Portland, ME 04103-1815 | 2019-12-13 |
| 1962043521 | Ladan Radafshar | Counselor | 1017 Sw Morrison St Ste 315, Portland, OR 97205-2628 | 2019-10-04 |
| 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.