Cottage Grove Counseling Clinic, Inc.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

COTTAGE GROVE COUNSELING CLINIC, INC.

Practice address

411 Washington Ave
Cottage Grove, OR 97424-2060

Phone

(541) 942-8060

Fax

(541) 942-9849

NPI assigned

Mar 30, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gary N Reiss, LCSWNPI 1588719595

Title

Director

Phone

(541) 686-8060

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sharon Lynn Emery, LMFT

  • Marriage & Family Therapist
  • Eugene, OR
  • NPI 1932221405
  Medicare reassignment NPD
• Gary Neal Reiss, LCSW

  • Clinical Social Worker
  • Eugene, OR
  • NPI 1588719595
  NPD (past) Authorized official
• Howard Keith McConnell, PHD

  • Exercise & Sports Psychologist
  • Cottage Grove, OR
  • NPI 1821217118
  NPD (past)
• Michael Bryan Tripp Sr., LMT

  • Contractor
  • Cottage Grove, OR
  • NPI 1730366998
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023138088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 786",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974240033",
            "telephone_number": "541-942-8060",
            "fax_number": "541-942-9849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 WASHINGTON AVE",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974242060",
            "telephone_number": "541-942-8060",
            "fax_number": "541-942-9849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COTTAGE GROVE COUNSELING CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REISS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "541-686-8060",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shary Conley, LPN
• Ann Marie Cooley, MD
• Christopher Johnathan Cooper
• Davide Jeanette Costley, MA, LPC
• Cottage Counseling, LLC
• Cottage Grove Physical Therapy Services, Inc
• Cottage Grove SNF Healthcare LLC (Cottage Grove Post Acute)
• Covered Bridge Physical Therapy LLC
• Elizabeth A Cox
• Lily Mahala Cranor, MD

• Mental Health Counselor in Cottage Grove, OR
• Providers in Cottage Grove, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.