Active NPI
Travis Shaddy
- Addiction (Substance Use Disorder) Counselor
- Coburg, OR
National Provider Identifier
1174449201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- T-25-6129
- Practice address
- 1 Serenity LN
Coburg, OR 97408-9350 - Phone
- (541) 687-1110
- NPI assigned
- Jun 24, 2026
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | T-25-6129 | OR | Primary |
Addresses
Primary practice location
1 Serenity LN
Coburg, OR 97408-9350
Mailing address
1 Serenity LN
Coburg, OR 97408-9350
Phone (541) 687-1110
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Serenity Lane | 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.
-
- Substance Abuse Rehabilitation Facility
- Coburg, OR
- NPI 1467283069
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1782259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782259200000",
"number": "1174449201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 SERENITY LN",
"city": "COBURG",
"state": "OR",
"postal_code": "974089350",
"telephone_number": "541-687-1110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 SERENITY LN",
"city": "COBURG",
"state": "OR",
"postal_code": "974089350",
"telephone_number": "541-687-1110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADDY",
"first_name": "TRAVIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-06-24",
"last_updated": "2026-06-24",
"certification_date": "2026-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "T-25-6129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coburg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.