ROSEBURG THERAPY LLC NPI 1538665013

NPI Information

NPI: 1538665013
Provider Name: ROSEBURG THERAPY LLC
Classification: Counselor - 101YM0800X
Entity Type: Organization

Specialization: Mental Health

Address:
272 NW MEDICAL LOOP STE E
ROSEBURG, OR
ZIP 97471
Phone: (541) 900-4285
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ROSEBURG THERAPY LLC is a mental health counselor in Roseburg, OR. ROSEBURG THERAPY LLC NPI is 1538665013. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

272 NW MEDICAL LOOP STE E
ROSEBURG, OR
ZIP 97471-545
Phone: (541) 900-4285
Fax: (888) 810-2993

The provider's authorized official is Robert Josh Lydon .
The authorized official title is Owner/operator and has the following contact phone number (541) 900-4285.

The enumeration date for this NPI number is 4/3/2018 and was last updated on 9/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1041C0700X	Social Worker	Clinical	L7631	OREGON	No
2	101YM0800X	Counselor	Mental Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	500743892	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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