Umpqua Family Therapy LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

UMPQUA FAMILY THERAPY LLC

Practice address

1299 NW Ellan St Ste 2
Roseburg, OR 97470-2031

Phone

(458) 802-3883

Fax

(541) 900-1840

NPI assigned

Mar 17, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Meredith Ann Concepcion, LCSWNPI 1265833388

Title

Owner/Provider

Phone

(458) 802-3883

Specialties & licenses 3

Addresses

Other identifiers 4

Other names 3

• Meredith Concepcion Doing business as
• Meredith Concepcion, LCSW Doing business as
• Meredith A Yost-Concepcion Other name

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/26492/brand/1/csg/1/fhir/r4

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Meredith Ann Concepcion, LCSW

  • Clinical Social Worker
  • Roseburg, OR
  • NPI 1265833388
  Medicare reassignment NPD Authorized official
• Anthony P Houston, LICSW LMHC CDP MAC

  • Mental Health Counselor
  • Portland, OR
  • NPI 1669615100
  Medicare reassignment NPD
• Rachel Suzanne Judd

  • Clinical Social Worker
  • Roseburg, OR
  • NPI 1891457735
  NPD
• Rummy Rodriguez, CSWA

  • Clinical Social Worker
  • Roseburg, OR
  • NPI 1740942937
  NPD
• Thomas Barber

  • Counselor
  • Roseburg, OR
  • NPI 1093642662

  Single Specialty

  NPD (past)
• Hilary Bons

  • Clinical Social Worker
  • Roseburg, OR
  • NPI 1154255099
  NPD (past)
• Amanda Rense

  • Student in an Organized Health Care Education/Training Program
  • Roseburg, OR
  • NPI 1114873072
  NPD (past)

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

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629676800000",
    "number": "1104401439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1299 NW ELLAN ST STE 2",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974702031",
            "telephone_number": "458-802-3883",
            "fax_number": "541-900-1840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1299 NW ELLAN ST STE 2",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974702031",
            "telephone_number": "458-802-3883",
            "fax_number": "541-900-1840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UMPQUA FAMILY THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-17",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A",
        "authorized_official_last_name": "CONCEPCION",
        "authorized_official_first_name": "MEREDITH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "458-802-3883",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14105272",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW LICENSE",
            "identifier": "L7566",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES  BUSINESS NPI",
            "identifier": "1104401439",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1265833388",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meredith Concepcion",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Meredith Concepcion, LCSW",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Meredith A Yost-Concepcion",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Umpqua Medical Group, LLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; 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.