Serenity Lane

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

13-12-59 Issued in OR

Legal business name

SERENITY LANE

Practice address

2575 NW Kline St
Roseburg, OR 97471-8827

Phone

(541) 673-3504

Fax

(541) 673-4724

NPI assigned

Sep 7, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Anthony William Haynes, BS CADCII

Title

Program Coordinator

Phone

(541) 673-3504

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473206400000",
    "number": "1073060182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 NW KLINE ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974718827",
            "telephone_number": "541-673-3504",
            "fax_number": "541-673-4724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 NW KLINE ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974718827",
            "telephone_number": "541-673-3504",
            "fax_number": "541-673-4724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY LANE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-07",
        "last_updated": "2016-09-07",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PROGRAM COORDINATOR",
        "authorized_official_telephone_number": "541-673-3504",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BS CADCII"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "13-12-59",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bradley H Seely, MD
• David G Seibel, DO
• Mary Lee Seidler, RN
• Mary Selken, CADC
• Polly M Sepulvado, M.D.
• Kenneth Edward Serkownek, PHD
• Erin Suzanne Severson-Hobson, RPH
• Kimberly Sewell
• Linda L Sewell, MD
• Ernst Udey Shadbolt, CADC I

• Addiction (Substance Use Disorder) Counselor in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.