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ELINA ELLA KING
Complete NPI Record 1023648839
Counselor - Mental Health in Portland, OR

NPI Status: Active since January 21, 2020

Contact Information

12511 SE RAYMOND ST
PORTLAND, OR
ZIP 97236
Phone: (503) 761-2580
Fax: (503) 761-2584

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Other Last Name
  7. Provider Other First Name
  8. Provider Other Middle Name
  9. Provider Other Last Name Type Code
  10. Provider First Line Business Mailing Address
  11. Provider Business Mailing Address City Name
  12. Provider Business Mailing Address State Name
  13. Provider Business Mailing Address Postal Code
  14. Provider Business Mailing Address Country Code If outside U S
  15. Provider Business Mailing Address Telephone Number
  16. Provider Business Mailing Address Fax Number
  17. Provider First Line Business Practice Location Address
  18. Provider Business Practice Location Address City Name
  19. Provider Business Practice Location Address State Name
  20. Provider Business Practice Location Address Postal Code
  21. Provider Business Practice Location Address Country Code If outside U S
  22. Provider Business Practice Location Address Telephone Number
  23. Provider Business Practice Location Address Fax Number
  24. Provider Enumeration Date
  25. Last Update Date
  26. Provider Gender Code
  27. Healthcare Provider Taxonomy Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Is Sole Proprietor
  30. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1023648839. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1023648839
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: ELINA
The first name of the provider, if the provider is an individual.
Provider Middle Name: ELLA
The middle name of the provider, if the provider is an individual.
Provider Other Last Name: NIKITINA
Other last name by which the provider being identified is or has been known.
Provider Other First Name: ELVIRA
Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only.
Provider Other Middle Name: OLEGOVNA
Other middle name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider middle name’’ if the provider is or has been known by a different last name only.
Provider Other Last Name Type Code: 5
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 3587 HEATHROW WAY
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: MEDFORD
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: OR
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 975044004
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 5418588170
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 5418588167
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 12511 SE RAYMOND ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: PORTLAND
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: OR
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 972363931
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 5037612580
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 5037612584
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 1/21/2020
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 11/16/2021
The date that a record was last updated or changed.
Provider Gender Code: F
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 101YM0800X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 11/16/2021