Active NPI
Gwendolyn Kaye Potter
- Mental Health Counselor
- Grants Pass, OR
National Provider Identifier
1184904864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 1545 Harbeck Rd
Grants Pass, OR 97527-5605 - Phone
- (541) 476-2373
- Fax
- (541) 295-3069
- NPI assigned
- Aug 25, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 03-07-35 | OR | |
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
1545 Harbeck Rd
Grants Pass, OR 97527-5605
Mailing address
1215 SW G St
Grants Pass, OR 97526-2544
Phone (541) 476-2373
Other practice location 1
1215 SW G St
Grants Pass, OR 97526-2544
Phone (541) 476-2373
Other names 1
- Ms. Gwendolyn Kaye Randolph
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 |
|---|---|---|---|
| Options for Southern Oregon | Past | Accepting new patients | |
| Options for Southern Oregon | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Grants Pass, OR
- NPI 1558366492
-
- Primary Care Clinic/Center
- Grants Pass, OR
- NPI 1952708422
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559260800000",
"number": "1184904864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1215 SW G ST",
"city": "GRANTS PASS",
"state": "OR",
"postal_code": "975262544",
"telephone_number": "541-476-2373",
"fax_number": "541-476-1526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1545 HARBECK RD",
"city": "GRANTS PASS",
"state": "OR",
"postal_code": "975275605",
"telephone_number": "541-476-2373",
"fax_number": "541-295-3069"
}
],
"practiceLocations": [
{
"address_1": "1215 SW G St",
"address_purpose": "LOCATION",
"city": "Grants Pass",
"state": "OR",
"postal_code": "975262544",
"country_code": "US",
"telephone_number": "541-476-2373",
"fax_number": "541-476-1526",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "POTTER",
"first_name": "GWENDOLYN",
"middle_name": "KAYE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-25",
"last_updated": "2019-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "03-07-35",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "GWENDOLYN",
"last_name": "RANDOLPH",
"middle_name": "KAYE",
"prefix": "MS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Grants Pass, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.