Active NPI
Jennifer Dawn Eichlin
- Mental Health Counselor
- Brookings, OR
National Provider Identifier
1063241982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 24-QMHP-R-3019
- Practice address
- 615 5TH St
Brookings, OR 97415-9199 - Phone
- (541) 708-9581
- NPI assigned
- Jul 30, 2024
- 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 | 24-QMHP-R-3019 | OR | Primary |
Addresses
Primary practice location
615 5TH St
Brookings, OR 97415-9199
Mailing address
33630 Ophir Rd
Gold Beach, OR 97444-8510
Phone (416) 987-1445
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 |
|---|---|---|---|
| 24-QMHP-R-3019 | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723075200000",
"number": "1063241982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33630 OPHIR RD",
"city": "GOLD BEACH",
"state": "OR",
"postal_code": "974448510",
"telephone_number": "416-987-1445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 5TH ST",
"city": "BROOKINGS",
"state": "OR",
"postal_code": "974159199",
"telephone_number": "541-708-9581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EICHLIN",
"first_name": "JENNIFER",
"middle_name": "DAWN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-30",
"last_updated": "2024-08-08",
"certification_date": "2024-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "24-QMHP-R-3019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookings, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.