Active NPI
Jill R Bird, QMHA, PSS, PWS, THW
- Mental Health Counselor
- Woodburn, OR
National Provider Identifier
1043772411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 23-QMHA-R-3419
- Practice address
- 1605 E Lincoln Rd
Woodburn, OR 97071-5137 - Phone
- (503) 982-9300
- Fax
- (503) 982-9308
- NPI assigned
- Apr 3, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | THW3372 | OR | |
| Mental Health Counselor | 101YM0800X | 23-QMHA-R-3419 | OR | Primary |
Addresses
Primary practice location
1605 E Lincoln Rd
Woodburn, OR 97071-5137
Mailing address
1605 E Lincoln Rd
Woodburn, OR 97071-5137
Phone (503) 982-9300
Other practice location 1
2555 Silverton Rd NE
Salem, OR 97301-0837
Phone (503) 983-1610
Other practice location 2
1599 State St
Salem, OR 97301-4255
Phone (503) 983-1610
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| THW000003372 | Other | OR | OREGON HEALTH AUTHORITY |
| 23-QMHA-R-3419 | Other | OR | MENTAL HEALTH AND ADDICTION CERTIFICATION BOARD OF OREGON |
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 |
|---|---|---|---|
| 23-QMHA-R-3419 | OR | MD | Mental Health Counselor |
| THW3372 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678924800000",
"number": "1043772411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1605 E LINCOLN RD",
"city": "WOODBURN",
"state": "OR",
"postal_code": "970715137",
"telephone_number": "503-982-9300",
"fax_number": "503-982-9308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1605 E LINCOLN RD",
"city": "WOODBURN",
"state": "OR",
"postal_code": "970715137",
"telephone_number": "503-982-9300",
"fax_number": "503-982-9308"
}
],
"practiceLocations": [
{
"address_1": "2555 Silverton Rd NE",
"address_purpose": "LOCATION",
"city": "Salem",
"state": "OR",
"postal_code": "973010837",
"country_code": "US",
"telephone_number": "503-983-1610",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1599 State St",
"address_purpose": "LOCATION",
"city": "Salem",
"state": "OR",
"postal_code": "973014255",
"country_code": "US",
"telephone_number": "503-983-1610",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BIRD",
"first_name": "JILL",
"middle_name": "R",
"credential": "QMHA, PSS, PWS, THW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-03",
"last_updated": "2023-03-16",
"certification_date": "2023-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "THW3372",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "23-QMHA-R-3419",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON HEALTH AUTHORITY",
"identifier": "THW000003372",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MENTAL HEALTH AND ADDICTION CERTIFICATION BOARD OF OREGON",
"identifier": "23-QMHA-R-3419",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodburn, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.