Active NPI
Jill L Smith, MA
- Professional Counselor
- Eugene, OR
National Provider Identifier
1073087870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 1050 Willagillespie Rd Ste 103
Eugene, OR 97401-6718 - Phone
- (458) 209-4080
- NPI assigned
- Jan 15, 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | R5459 | OR | |
| Professional Counselor | 101YP2500X | Primary |
Addresses
Primary practice location
1050 Willagillespie Rd Ste 103
Eugene, OR 97401-6718
Mailing address
1050 Willagillespie Rd Ste 103
Eugene, OR 97401-6718
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2025 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R5459 | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548028800000",
"number": "1073087870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1050 WILLAGILLESPIE RD STE 103",
"city": "EUGENE",
"state": "OR",
"postal_code": "974016718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 WILLAGILLESPIE RD STE 103",
"city": "EUGENE",
"state": "OR",
"postal_code": "974016718",
"telephone_number": "458-209-4080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JILL",
"middle_name": "L",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-15",
"last_updated": "2019-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "R5459",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.