NPIMap

Organization Active NPI

Jefferson Community Counseling Center

  • Community/Behavioral Health Agency
  • Port Townsend, WA
National Provider Identifier
1083701015
Registry record updated Feb 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
JEFFERSON COMMUNITY COUNSELING CENTER
Practice address
884 W Park Ave
Port Townsend, WA 98368-2273
Phone
(360) 385-0321
Fax
(360) 379-2547
NPI assigned
Oct 10, 2006
Last updated
Feb 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2022

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

Authorized official

Name
Tonya M FergusonNPI 1699205401
Title
Director of Operations and Complian
Phone
(360) 385-0321

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

884 W Park Ave
Port Townsend, WA 98368-2273

Mailing address

PO Box 565
Port Townsend, WA 98368-0565
Phone (360) 385-0321

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040311000167 WA Part B Supplier - Clinic/Group Practice 6103715081 Receives reassigned benefits from 20 practitioners
Practice locations: Port Townsend, WA

National Provider Directory

National Provider Directory

Locations

686 Lake St
Ste 100
Port Townsend, WA 98368

884 W Park Ave
Port Townsend, WA 98368

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/discoverybh/r4/

Practitioners & affiliated clinicians

Practitioners 179

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 179

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644192000000",
    "number": "1083701015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 565",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983680565",
            "telephone_number": "360-385-0321",
            "fax_number": "360-379-2547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "884 W PARK AVE",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682273",
            "telephone_number": "360-385-0321",
            "fax_number": "360-379-2547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COMMUNITY COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "TONYA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS AND COMPLIAN",
        "authorized_official_telephone_number": "360-385-0321"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Townsend, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.