Active NPI
Gretchen Leanne Ericson, LPC
- Professional Counselor
- Medford, OR
National Provider Identifier
1245348630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C2534
- Practice address
- 11 Tripp St
Medford, OR 97504-7343 - Phone
- (541) 324-1255
- Fax
- (541) 277-2038
- NPI assigned
- Aug 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C2534 | OR | Primary |
Addresses
Primary practice location
11 Tripp St
Medford, OR 97504-7343
Mailing address
1510 Miracle Lane
Medford, OR 97504
Phone (541) 324-1255
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240828004413 | OR | Practitioner - Mental Health Counselor | 3870032303 | Practice locations: Medford, OR |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C2534 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637280000000",
"number": "1245348630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1510 MIRACLE LANE",
"city": "MEDFORD",
"state": "OR",
"postal_code": "97504",
"telephone_number": "541-324-1255",
"fax_number": "541-227-2038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 TRIPP ST",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975047343",
"telephone_number": "541-324-1255",
"fax_number": "541-277-2038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERICSON",
"first_name": "GRETCHEN",
"middle_name": "LEANNE",
"name_prefix": "Ms.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-27",
"last_updated": "2021-11-19",
"certification_date": "2021-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C2534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.