John Deroin

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

22-QMHP-R-1561 Issued in OR

Practice address

1 Serenity LN
Coburg, OR 97408-9350

Phone

(541) 687-1110

NPI assigned

Dec 23, 2014

Last updated

Jun 27, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: john.deroin.p1@direct.lanecounty.nextgenshare.com
• Direct secure messaging: john.deroin.p2@direct.lanecounty.nextgenshare.com

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.

• Serenity Lane

  • Substance Abuse Rehabilitation Facility
  • Coburg, OR
  • NPI 1467283069
  NPD
• Lane County Oregon

  dba Community health Centers of Lane County

  • Federally Qualified Health Center (FQHC)
  • Springfield, OR
  • NPI 1326138314
  NPD (past)
• Serenity Lane

  • Substance Abuse Rehabilitation Facility
  • Coburg, OR
  • NPI 1104934892
  NPD (past)

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

{
    "created_epoch": "1419292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1184012379",
    "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": [
        {
            "address_1": "151 W 7th Ave",
            "address_2": "Room #163",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974011100",
            "country_code": "US",
            "telephone_number": "541-682-4464",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2411 Martin Luther King Jr Blvd",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974015824",
            "country_code": "US",
            "telephone_number": "541-682-3608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEROIN",
        "first_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-23",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "06-03-62",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "22-QMHP-R-1561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coburg Rural Fire Protection District
• Stephen Conn Jr.
• Susan Reining Connick, CADC 1
• Christopher Michael Coronado
• Jace Decker, LPC, CADC I
• Kelly Jean Doty
• Amy Drake
• Bradley Frank Durham, CADC1R
• Jeffrey McLean Dutton
• Megan Carolina Ely

• Mental Health Counselor in Coburg, OR
• Providers in Coburg, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.