KEITH ELLIS JACKSON (NPI# 1881289338) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881289338 |
| Entity Type | Individual |
| Full Name | KEITH ELLIS JACKSON |
| Gender | Male |
| Credential | LMFT |
| Practice Address | 3311 Ne Mlk Blvd Portland OR 97212-2086 |
| Practice Telephone | 5038908074 |
| Mailing Address | 8600 Ne 13th Pl Vancouver WA 98665-9534 |
| Mailing Telephone | 3608528139 |
| Mailing Fax Number | 3608528139 |
| Certification Date | 2021-03-06 |
| Enumeration Date | 2021-03-06 |
| Last Update Date | 2021-03-06 |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | Group | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|---|
| Y | 101YP2500X | Counselor Specialization: Professional | 48284 | CA | Behavioral Health & Social Service Providers |
| Endpoint Type | Endpoint | Affiliation | Affiliation Address | Use | Content |
|---|---|---|---|---|---|
| CONNECT URL | Vancouver | Mind Solutions LLC | 3311 Ne Mlk Blvd, Portland, OR 972122086 | Health Information Exchange (HIE) | CSV |
| Street Address | 3311 NE MLK BLVD |
| City | PORTLAND |
| State | OR |
| Zip Code | 97212-2086 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154569382 | James Snider Christy | Chiropractor | 3311 Ne Mlk Blvd Ste 202, Portland, OR 97212-2086 | 2009-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063035293 | Candy Lynn Gordon | Counselor · Addiction (Substance Use Disorder) | 3311 Ne Mlk Jr Blvd Ste 104, Portland, OR 97212-2086 | 2020-05-21 |
| 1356973945 | Ailene Joyce Farkac | Social Worker | 3311 Ne Martin Luther King Jr Blvd Ste 104, Portland, OR 97212-2086 | 2020-02-11 |
| 1033679279 | Sherri Warren | Massage Therapist | 3311 Ne Mlk Jr Blvd, Portland, OR 97212-2086 | 2019-03-22 |
| 1245732544 | Walter Irving Chase | Rehabilitation Counselor | 3311 Ne Martin Luther King Blvd, Portland, OR 97212-2086 | 2018-03-02 |
| 1457894388 | Juanita Bradley | Peer Specialist | 3311 Ne Martin Luther King Jr Blvd, Portland, OR 97212-2086 | 2016-11-26 |
| 1912154352 | Alexis-Tran Huyen Nguyen | Chiropractor | 3311 Ne Mlk Jr Blvd Ste 202, Portland, OR 97212-2086 | 2008-08-27 |
| 1538789656 | Wilford Johnson | Peer Specialist | 3311 Ne Martin Luther King Jr Blvd Ste 104, Portland, OR 97212-2086 | 2020-04-18 |
| 1487282521 | Jermaine Christopher Mason | Peer Specialist | 3311 Ne Martin Luther King Jr Blvd Ste 104, Portland, OR 97212-2086 | 2020-04-01 |
| 1073145777 | Lakeesha Dumas | Peer Specialist | 3311 Ne Mlk Jr Blvd, Portland, OR 97212-2086 | 2020-02-10 |
| 1356906788 | Mind Solutions LLC | Clinic/Center · Mental Health (Including Community Mental Health Center) | 3311 Ne Mlk Jr Blvd, Portland, OR 97212-2086 | 2019-05-01 |
| Find all providers in zip 97212-2086 | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205423704 | Oregon Cvs Pharmacy LLC · Cvs Pharmacy#11392 | Pharmacy · Community/Retail Pharmacy | 1821 Ne 33rd Avenue, Portland, OR 97212 | 2020-12-30 |
| 1497223051 | Shira Dennis | Behavioral Analyst | 3424 Ne Tillamook St., Portland, OR 97212 | 2018-11-12 |
| 1659890317 | Cidnee Potter | Doula | 2915 Ne Mlk Jr Blvd, Portland, OR 97212 | 2017-09-14 |
| 1588194187 | Ann M Staple | Counselor · Mental Health | 2905 Ne Tillamook St, Portland, OR 97212 | 2017-06-15 |
| 1780129502 | Noelle Denise King | Naturopath | 2540 Ne Martin Luther King Jr Blvd Femelle Integrative, Suite A, Portland, OR 97212 | 2017-01-03 |
| 1285085100 | Jessica Battin | Massage Therapist | 2310 Ne 8th Ave #2, Portland, OR 97212 | 2016-06-22 |
| 1316311830 | Dr Elise Schroeder | Clinic/Center | 3531 Ne 15th Ave Suite A, Portland, OR 97212 | 2015-11-20 |
| 1467820738 | Ayanna Askari | Counselor · Addiction (Substance Use Disorder) | 3655 N E Grand Ave, Portland, OR 97212 | 2015-09-03 |
| 1053797167 | Iliana Henriquez | Social Worker · School | 3500 Ne Martin Luther King Blvd Suite 200, Portland, OR 97212 | 2015-07-31 |
| 1417346834 | Emily Mcdonough Comerford | Case Manager/Care Coordinator | 1823 Ne 8th Avenue, Kinship House, Portland, OR 97212 | 2015-01-22 |
| Find all providers in zip 97212 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710565692 | Head and Heart Therapy, LLC | 1722 Nw Raleigh St Ofc 325, Portland, OR 97209-1753 | 2021-03-31 | |
| 1407431703 | Deborah Lynn Harrison | 1400 Nw 133rd Ave, Portland, OR 97229-4504 | 2021-03-17 | |
| 1366036840 | Rose City Therapists, LLC | 3747 Se Morrison St, Portland, OR 97214-3209 | 2021-02-24 | |
| 1518558022 | Sara Narayan | 1724 Se Mulberry Ave, Portland, OR 97214-4764 | 2021-01-27 | |
| 1619567609 | Siri Smithback | 2016 Ne Highland St, Portland, OR 97211-5323 | 2021-01-22 | |
| 1871181933 | Rise Holistic Healing, LLC | 123 Forest Avenue, Portland, ME 04101-1907 | 2021-01-05 | |
| 1881298081 | Maximiliano Nealon | 1204 Se 51st Ave, Portland, OR 97215-2615 | 2020-11-28 | |
| 1811590854 | Diana K Oxley | 2929 Sw Multnomah Blvd Ste 107, Portland, OR 97219-4070 | 2020-11-20 | |
| 1063013373 | Ruth Tessema | 2120 Ne 166th Dr, Portland, OR 97230-5558 | 2020-11-03 | |
| 1568061547 | Amanda Marie Bucci | 19 South St Ste 6, Portland, ME 04101-3963 | 2020-10-21 | |
| Find all providers in PORTLAND | ||||
| City | PORTLAND |
| Zip Code | 97212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720123979 | Jackson Public Schools Hardy Clinic | Registered Nurse | 545 Ellis Ave, Jackson, MS 39209-6202 | 2007-02-21 |
| 1972823367 | Keith Ellis | Physical Therapist | 751 E Porter Ave Ste 2, Chesterton, IN 46304-9111 | 2010-06-08 |
| 1194166942 | Keith Ellis | Counselor | 11 Ward St, Somerville, MA 02143-4214 | 2013-07-09 |
| 1780262048 | Austin Ellis Mcintosh | Massage Therapist | 201 Keith St Sw Ste 56, Cleveland, TN 37311-5867 | 2021-03-30 |
| 1144654666 | Keith Lawrence Ellis | Nurse Practitioner · Pediatrics | 46 Albion St, Bridgeport, CT 06605-2602 | 2013-09-03 |
| 1407849441 | Keith L Ellis | Marriage & Family Therapist | 557 Glover Ave, Suite 3, Enterprise, AL 36330-2024 | 2005-08-24 |
| 1922005388 | Ira Keith Ellis | Family Medicine | 2084 W Main St, Milan, TN 38358-3515 | 2005-06-30 |
| 1356490775 | Keith Errett Ellis | Family Medicine | 1107 E 66th St, Savannah, GA 31404-5701 | 2007-01-09 |
| 1326434028 | Keith Ellis Morse | Pediatrics | 725 Welch Rd, Palo Alto, CA 94304-1601 | 2015-04-09 |
| 1033275896 | Keith W. Ellis | Internal Medicine | 2115 S Fremont Ave, Suite 2300, Springfield, MO 65804-2239 | 2006-12-28 |
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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.