Glyn T. Deputy, LPC
Individual provider Active NPI Professional Counselor · Grants Pass, OR
NPI 1164541991 · NPPES record last updated Mar 17, 2015
Key facts
- NPI
- 1164541991
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- C2709 (OR)
- Practice address
- 1215 SW G. Street
Grants Pass, OR 97526-2544 - Phone
- (541) 476-2373
- Fax
- (541) 476-1526
- NPI assigned
- Mar 29, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- City of Valdez
Practice addresses (Care Compare)
911 Meals Ave
Valdez, AK 99686-0046
Phone (907) 835-2838
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241219001058 | AK | Practitioner - Mental Health Counselor | 5799212403 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-3109 | ID | MD | Counselor |
| C2709 | OR | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Health & Services Washington | Current |
Accepting new patients | |
| City of Valdez | Current |
Accepting new patients |
Locations
1818 E Rezanof Dr
Kodiak, AK 99615
Phone (907) 481-2400
911 Meals Ave
Valdez, AK 99686
Phone (907) 835-2249
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LPC-3109 | ID | |
| Professional Counselor | 101YP2500X | C2709 | OR | Yes |
Addresses
Primary practice location
1215 SW G. Street
Grants Pass, OR 97526-2544
Mailing address
1215 SW G. Street
Grants Pass, OR 97526-2544
Phone (541) 476-2373
Other providers in Grants Pass, OR
- Thayanne Camargo Delima-Tokarz
- Janae Lee Delzell
- Dena Lynn Demello
- Lee Denham
- Dental Vision PC
- Kathryn Ruth Desantis
- Carolyn Louise Descalso
- Desy P Wilson DDS Ms PC
- Carolyn I Diaz
- James Thomas Dibb
All providers in Grants Pass, OR · Professional Counselor in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.