Individual provider Active NPI

Bernice Agyeiwaa Essien, CT

  • Mental Health Counselor
  • Klamath Falls, OR
National Provider Identifier
1114777612
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
QMHP-R-1397 Issued in OR
Practice address
714 Main St Ste 200
Klamath Falls, OR 97601-6010
Phone
(541) 880-4921
NPI assigned
Mar 26, 2024
Last updated
Mar 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X QMHP-R-1397 OR Primary

Addresses

Primary practice location

714 Main St Ste 200
Klamath Falls, OR 97601-6010

Mailing address

7 North Potomac Street, Hagerstown Maryland 21740
Maryland, Hagerstown, MD 21740
Phone (240) 420-1850

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260601002865 MD Practitioner - Clinical Social Worker 7911477864 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1301 York Rd
Suite 800
Lutherville, MD 21093-6065

3905 National Dr
Suite 200
Burtonsville, MD 20866-6143

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
QMHP-R-1397ORMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Grace William Health Systems CurrentSince Mar 31, 2024 Accepting new patients

Locations

714 Main St
Ste 200
Klamath Falls, OR 97601
Phone (443) 865-6593

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1711411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1114777612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 NORTH POTOMAC STREET, HAGERSTOWN MARYLAND 21740",
            "city": "MARYLAND, HAGERSTOWN",
            "state": "MD",
            "postal_code": "21740",
            "telephone_number": "240-420-1850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 MAIN ST STE 200",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976016010",
            "telephone_number": "541-880-4921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESSIEN",
        "first_name": "BERNICE",
        "middle_name": "AGYEIWAA",
        "name_prefix": "Dr.",
        "credential": "CT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-26",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "QMHP-R-1397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Klamath Falls, OR

Sources for this page

Verify at the official NPI Registry.