NPIMap

Organization Active NPI

Sarah Soric Therapy LLC

Doing business as Dynamic Self Recovery

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Albany, OR
National Provider Identifier
1083205298
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
SARAH SORIC THERAPY LLC
Doing business as
Dynamic Self Recovery
Practice address
1010 11TH Ave SW
Albany, OR 97321-2019
Phone
(541) 829-1199
Fax
(833) 770-4969
NPI assigned
Jan 30, 2021
Last updated
Jan 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Authorized official

Name
Carol Ann McCollum
Title
Supervisor
Phone
(541) 621-2698

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1010 11TH Ave SW
Albany, OR 97321-2019

Mailing address

1010 11TH Ave SW
Albany, OR 97321-2019
Phone (541) 791-7193

Other names 1

  • Dynamic Self Recovery Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL referrals@dynamicsr.hush.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231226000854 OR Part B Supplier - Clinic/Group Practice 6608226105 Receives reassigned benefits from 4 practitioners
Practice locations: Albany, OR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2226159Sarah Soric Therapy LLC Dba Dynamic Self Recovery1010 11TH Ave SW, Albany, OR 97321Certificate of waiverMay 25, 2027

National Provider Directory

National Provider Directory

Locations

433 3rd Ave SE
Albany, OR 97321
Phone (541) 791-7193

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1611964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1083205298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 11TH AVE SW",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973212019",
            "telephone_number": "541-791-7193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 11TH AVE SW",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973212019",
            "telephone_number": "541-829-1199",
            "fax_number": "833-770-4969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SARAH SORIC THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-30",
        "last_updated": "2024-01-05",
        "certification_date": "2023-12-28",
        "status": "A",
        "authorized_official_last_name": "MCCOLLUM",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "541-621-2698"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "referrals@dynamicsr.hush.com",
            "affiliation": "N",
            "endpointDescription": "secure email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1010 11th Ave SW",
            "city": "Albany",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973212019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Dynamic Self Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albany, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.