COLLECTIVE CARE CLINIC, LLC (NPI# 1780221499) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780221499 |
| Entity Type | Organization |
| Organization Name | COLLECTIVE CARE CLINIC, LLC |
| Practice Address |
1130 Sw Morrison St Ste 619 Portland OR 97205-2217 |
| Practice Telephone | 5033130028 |
| Mailing Telephone | 5033130028 |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2019-12-02 |
| Authorized Official Name | DR. JILL ASHLEY DAVIDSON (PSYCHOLOGIST / OWNER) |
| Authorized Official Telephone | 5033130028 |
| Authorized Official Credential | PSY.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
Behavioral Health & Social Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | COLLECTIVE CARE CLINIC, LLC | 1130 Sw Morrison St Ste 619, Portland, OR 97205 |
| Street Address |
1130 SW MORRISON ST STE 619 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97205-2217 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821358813 | Katherine Sutherland Sturges | Counselor | 1130 Sw Morrison St Ste 619, Portland, OR 97205-2217 | 2012-05-23 |
| 1033692991 | Portland Anxiety Clinic | Counselor | 1130 Sw Morrison St Ste 619, Portland, OR 97205-2217 | 2018-09-07 |
| 1114470721 | Amy Duede | Counselor | 1130 Sw Morrison St Ste 619, Portland, OR 97205-2217 | 2016-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871026062 | Leila Soltani | Dentist | 430 Sw 13th Ave Apt 2010, Portland, OR 97205 | 2017-04-05 |
| 1114374949 | Elizabeth Alire | Counselor | 1411 Sw Morrison St., Portland, OR 97205 | 2016-05-23 |
| 1508237462 | Pacific Psychology and Comprehensive Health Center | Community/Behavioral Health | 1411 Sw Morrison Ave, Suite 310, Portland, OR 97205 | 2015-10-16 |
| 1265803761 | Alana Branson | Naturopath | 1033 Sw Yamhill Street, Suite 403, Portland, OR 97205 | 2015-10-10 |
| 1720458011 | Kate Ohene | Counselor | 1411 Sw Morrison Street, Suite 310, Portland, OR 97205 | 2015-09-30 |
| 1285004671 | Christina Nannette Mendoza | Counselor | 1411 Sw Morriston Street, 310, Portland, OR 97205 | 2015-09-29 |
| 1083095947 | Patricia Burton | Registered Nurse | 1312 Sw Washinghton, Portland, OR 97205 | 2015-06-16 |
| 1649663071 | Huey Holistic | Clinic/Center | 1221 Sw Yamill, Suite 300, Portland, OR 97205 | 2015-03-10 |
| 1376952796 | Joan Kendall Ayala | Counselor | 610 Sw Alder St Ste 915, Portland, OR 97205 | 2014-08-11 |
| 1316356165 | Satheara Sin | Massage Therapist | 1033 Sw Yamhill St. #403, Portland, OR 97205 | 2014-08-06 |
| Find all providers in zip 97205 | ||||
| Taxonomy Code | 103TB0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Cognitive & Behavioral |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740616325 | Kathleen Gregorich Hoffman | Psychologist | 3245 Nw Thurman St, Portland, OR 97210-1224 | 2013-09-16 |
| 1558708461 | Anthony Michael Duncan | Psychologist | 2236 Se Belmont St, Portland, OR 97214-2817 | 2013-05-31 |
| 1083998611 | Kaufman Psychological Services | Psychologist | 1321 Washington Ave Ste 102, Portland, ME 04103-3636 | 2011-09-30 |
| 1174813539 | Robert W Mclellarn, Phd | Psychologist | 5440 Sw Westgate Drive, Suite 175, Portland, OR 97221 | 2011-04-19 |
| 1346574449 | Jerusha Beth Detweiler-bedell | Psychologist | 5440 Sw Westgate Dr., #175, Portland, OR 97221-2436 | 2009-09-23 |
| 1386845048 | Morris Tiktin | Psychologist | 1201 Sw 12 Ave, Suite 300, Portland, OR 97205-2046 | 2007-05-30 |
| 1235341629 | Muriel D. Lezak | Psychologist | 2211 Sw 1st Ave, G10, Portland, OR 97201-5060 | 2007-05-05 |
| 1952528952 | Melisa L. Finch | Psychologist | 10201 Se Main St Ste 10, Portland, OR 97216-2937 | 2007-04-19 |
| 1992712103 | Maryann J Carroll | Psychologist | 25 Bedell St, Portland, ME 04103-1705 | 2006-08-01 |
| 1588642953 | Joseph Peter Gretsch | Psychologist | 818 Sw 3rd Ave, #148, Portland, OR 97204-2405 | 2006-01-05 |
| 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.