Hazel Berry
Individual provider Active NPI Mental Health Counselor · Brookings, OR
NPI 1184017444 · NPPES record last updated Mar 11, 2015
Key facts
- NPI
- 1184017444
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- C3692/ACTIVE (OR)
- Practice address
- 412 Alder St
Brookings, OR 97415-9014 - Phone
- (541) 813-2535
- Fax
- (541) 813-2536
- NPI assigned
- Mar 11, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- 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 |
|---|---|---|---|---|
| I20231128003392 | OR | Practitioner - Mental Health Counselor | 2163870338 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C3692/ACTIVE | OR | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adapt | Mental Health | Current | Accepting new patients |
| Adapt | Current |
Accepting new patients | |
| Adapt | Current |
Accepting new patients | |
| Curry Community Health | Past | Accepting new patients |
Locations
621 W Madrone St
Roseburg, OR 97470
Phone (541) 440-3571
548 SE Jackson St
Roseburg, OR 97470
Phone (541) 492-0241
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | C3692/ACTIVE | OR | Yes |
Addresses
Primary practice location
412 Alder St
Brookings, OR 97415-9014
Mailing address
94235 Moore St Ste 121
Gold Beach, OR 97444-9704
Phone (541) 813-2535
Other providers in Brookings, OR
- Mary Christine Barvoets
- Mallisa P Bates
- Holly Ann Battleson
- Suzanne Bedke
- Ashley N Benson
- Better Health Family Medical, LLC
- Raechele Darleen Bird
- Michael Edward Bisgrove
- Michelle L Bishop
- Jeanne A. Bisson
All providers in Brookings, OR · Mental Health 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 11, 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.