Active NPI
Kristine A Villanueva, LCSW
- Mental Health Counselor
- Salem, OR
National Provider Identifier
1083726236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2633
- Practice address
- 4035 12TH St. Cut Off SE
Suite 140
Salem, OR 97302 - Phone
- (503) 999-5971
- Fax
- (503) 391-7422
- NPI assigned
- Aug 31, 2006
- 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 | 2633 | OR | Primary |
Addresses
Primary practice location
4035 12TH St. Cut Off SE
Suite 140
Salem, OR 97302
Mailing address
2695 12TH PL SE
Salem, OR 97302-2537
Phone (503) 999-5971
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2633 | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456790400000",
"number": "1083726236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2695 12TH PL SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973022537",
"telephone_number": "503-999-5971",
"fax_number": "503-391-7422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4035 12TH ST. CUT OFF SE",
"address_2": "SUITE 140",
"city": "SALEM",
"state": "OR",
"postal_code": "97302",
"telephone_number": "503-999-5971",
"fax_number": "503-391-7422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLANUEVA",
"first_name": "KRISTINE",
"middle_name": "A",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2016-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "2633",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 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.