{
"Npi": {
"NPI": "1760903959",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BOLTON",
"FirstName": "FAITH",
"MiddleName": "HELENE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "CADCII/PSS/CRM/QMHAR",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BOLTON",
"OtherFirstName": "NOREEN",
"OtherMiddleName": "HELENE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "CADC II/PSS",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "211 SE CARUTHERS ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PORTLAND",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97214-4502",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-224-1044",
"MailingAddressFaxNumber": "971-260-0355",
"FirstLinePracticeLocationAddress": "17645 NW SAINT HELENS RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PORTLAND",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97231-1729",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-621-1069",
"PracticeLocationAddressFaxNumber": "503-621-0200",
"EnumerationDate": "06/28/2017",
"LastUpdateDate": "07/30/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "21-01-20005",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "15-CRM-180",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "24-QMHA-R-5226",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "175T00000X",
"TaxonomyName": "Peer Specialist",
"LicenseNumber": "THW000001262",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}