Active NPI
Elisabeth Erin Payne
- Mental Health Counselor
- Roseburg, OR
National Provider Identifier
1003552829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 215 SE Jackson St
Roseburg, OR 97470-3341 - Phone
- (541) 464-6660
- NPI assigned
- May 5, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
215 SE Jackson St
Roseburg, OR 97470-3341
Mailing address
1036 SE Douglas Ave.
Room Ch105A
Roseburg, OR 97470
Phone (541) 391-2636
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366697690 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651708800000",
"number": "1003552829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1036 SE DOUGLAS AVE.",
"address_2": "ROOM CH105A",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "97470",
"telephone_number": "541-391-2636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 SE JACKSON ST",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974703341",
"telephone_number": "541-464-6660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAYNE",
"first_name": "ELISABETH",
"middle_name": "ERIN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-05",
"last_updated": "2022-05-05",
"certification_date": "2022-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1366697690",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseburg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.