Active NPI
Gabrielle Johnson
- Addiction (Substance Use Disorder) Counselor
- Bend, OR
National Provider Identifier
1023615879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- T-21-813
- Practice address
- 155 NE Revere Ave Ste 150
Bend, OR 97701-4147 - Phone
- (541) 617-4544
- NPI assigned
- Oct 5, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | OR | ||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | T-21-813 | OR | Primary |
Addresses
Primary practice location
155 NE Revere Ave Ste 150
Bend, OR 97701-4147
Mailing address
155 NE Revere Ave Ste 150
Bend, OR 97701-4147
Phone (541) 617-4544
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T-21-813 | OR | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629676800000",
"number": "1023615879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "155 NE REVERE AVE STE 150",
"city": "BEND",
"state": "OR",
"postal_code": "977014147",
"telephone_number": "541-617-4544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 NE REVERE AVE STE 150",
"city": "BEND",
"state": "OR",
"postal_code": "977014147",
"telephone_number": "541-617-4544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "GABRIELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-05",
"last_updated": "2021-08-23",
"certification_date": "2021-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "OR",
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "T-21-813",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.