Individual provider Active NPI

Brandon R Johns

  • Mental Health Counselor
  • Salem, OR
National Provider Identifier
1265932321
Registry record updated Jan 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
19-QMHP-R-0014 Issued in OR
Practice address
750 Front St NE
Salem, OR 97301-1089
Phone
(503) 363-2021
NPI assigned
Feb 15, 2018
Last updated
Jan 12, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X
Mental Health Counselor 101YM0800X 19-QMHP-R-0014 OR Primary

Addresses

Primary practice location

750 Front St NE
Salem, OR 97301-1089

Mailing address

PO Box 17818
Salem, OR 97305-7818
Phone (503) 363-2021

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

State licenses

LicenseStateTypeSpecialty
19-QMHP-R-0014ORMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Bridgeway Recovery Services Addiction (Substance Use Disorder) CurrentSince Jan 15, 2023 Accepting new patients

Locations

750 Front St NE
Salem, OR 97301
Phone (503) 361-2660

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/bridgewayrecovery/r4/

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1518652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1265932321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17818",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973057818",
            "telephone_number": "503-363-2021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 FRONT ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973011089",
            "telephone_number": "503-363-2021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNS",
        "first_name": "BRANDON",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-15",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "19-QMHP-R-0014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; 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.