Active NPI
Benjamin David Peterson
- Mental Health Counselor
- Corvallis, OR
National Provider Identifier
1083987903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 4455 NE HW 20
Children'S Farm Home
Corvallis, OR 97330 - Phone
- (541) 758-5900
- NPI assigned
- Feb 23, 2012
- Sex
- Male
- Sole proprietor
- No
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 | Primary |
Addresses
Primary practice location
4455 NE HW 20
Children'S Farm Home
Corvallis, OR 97330
Mailing address
3415 SE Powell Blvd
Portland, OR 97202-3371
Phone (503) 234-9591
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 17, 2025 through Sep 17, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Breaking Free, LLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500422400000",
"number": "1083987903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3415 SE POWELL BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972023371",
"telephone_number": "503-234-9591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4455 NE HW 20",
"address_2": "CHILDREN'S FARM HOME",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "97330",
"telephone_number": "541-758-5900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "BENJAMIN",
"middle_name": "DAVID",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-02-23",
"last_updated": "2017-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2017; 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.