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FREDERICK DOUGLASS STATEN PH.D.,LPC, CADC III
NPI 1417216730
Counselor - Professional in Portland, OR

Active since May 07, 2012PECOS Enrolled
10920 SW BARBUR BLVD, PORTLAND, OR 97219(503) 244-4500(503) 244-2008 Get Directions Write a Review

NPPES record last updated: March 13, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Frederick Douglass Staten Ph.d.,lpc, Cadc Iii NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FREDERICK DOUGLASS STATEN PH.D.,LPC, CADC III (NPI 1417216730) is an individual professional provider in Portland, Oregon, licensed in Oregon (C4765) and active in the NPI registry since May 2012. He is enrolled in Medicare PECOS and is a graduate of Other (2011).

NPPES Registry Identity

NPI1417216730
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameFREDERICK DOUGLASS STATENCredential: PH.D.,LPC, CADC III
Location Address10920 SW BARBUR BLVDPortland, OR 97219-8600
Mailing AddressPo Box 8459Portland, OR 97207-8459 · (503) 230-9654
Phone(503) 244-4500
Fax(503) 244-2008
Sole ProprietorNo
Medical School CMSOtherGraduated 2011
Enumeration DateMay 7, 2012
Last NPPES UpdateMarch 13, 2026
NPPES CertifiedMarch 13, 2026
✔ NPI 1417216730 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
Licenses✔ Licensed in OR · C4765✔ Licensed in WA · LH60296096
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X
10920 SW BARBUR BLVD, Portland, OR 97219
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc. and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Frederick Douglass Staten Ph.d.,lpc, Cadc Iii is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7012495476
PECOS Enrollment IDI20260128002446
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EDIBEN YOONAN
Counselor (Addiction (Substance Use Disorder))
10920 SW BARBUR BLVD
PORTLAND, OR 97219
Multnomah County (503) 676-5482
PHOEBE CALDWELL
Counselor (Addiction (Substance Use Disorder))
10920 SW BARBUR BLVD
PORTLAND, OR 97219
Multnomah County (503) 676-5482
TINA MARIE KNAUTZ CADC II
Counselor (Addiction (Substance Use Disorder))
10920 SW BARBUR BLVD
PORTLAND, OR 97219
Multnomah County (503) 244-4500
MS. ZENA THOMAS MOREHEAD CSWA,CADC II
Counselor (Mental Health)
10920 SW BARBUR BLVD
PORTLAND, OR 97219
Multnomah County (503) 676-5482
NICHOLAS MATHIAS THOMAS CRAPSER MA
Counselor (Professional)
10920 SW BARBUR BLVD
PORTLAND, OR 97219
Multnomah County (360) 442-1451
ANNETTE LEANE JOHNSON CADC-R
Counselor (Addiction (Substance Use Disorder))
10920 SW BARBUR BLVD
PORTLAND, OR 97219
Multnomah County (541) 204-2849
MRS. LORRAINE ELLEN FOUCH CADCI
Counselor (Addiction (Substance Use Disorder))
10920 SW BARBUR BLVD
PORTLAND, OR 97219
Multnomah County (503) 244-4500
MYAH ROWAN SOVA CADC R
Counselor (Addiction (Substance Use Disorder))
10920 SW BARBUR BLVD
PORTLAND, OR 97219
Multnomah County (541) 687-1110

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Frederick Staten's NPI number?

The NPI number for Frederick Staten is 1417216730. It was assigned to this individual provider in the NPPES registry on May 7, 2012.

Where is Frederick Staten located?

Frederick Staten practices at 10920 SW Barbur Blvd, Portland, OR 97219. The listed phone number is (503) 244-4500.

What is Frederick Staten's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Frederick Staten enrolled in Medicare?

Yes. Frederick Staten is registered in the Medicare PECOS enrollment system.

What insurance does Frederick Staten accept?

Health plans from BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc., PacificSource Health Plans and Providence Health Plan and 1 other insurer list Frederick Staten as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Frederick Staten was last updated on March 13, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.