Polk County Mental Health

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

04-R-19 Issued in OR

Legal business name

POLK COUNTY MENTAL HEALTH

Practice address

557 21St St SE
Salem, OR 97301-6526

Phone

(503) 991-0226

NPI assigned

Apr 4, 2007

Organization subpart

No

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

Authorized official

Name

Susan Marie Klein, CADC-II QMHA BS

Title

Addictions Counselor

Phone

(503) 623-9289

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Polk County Mental Health Addiction Services Other name

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218672000000",
    "number": "1295857977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 21ST ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973016526",
            "telephone_number": "503-991-0226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 21ST ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973016526",
            "telephone_number": "503-991-0226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK COUNTY MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2008-08-14",
        "status": "A",
        "authorized_official_last_name": "KLEIN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "ADDICTIONS COUNSELOR",
        "authorized_official_telephone_number": "503-623-9289",
        "authorized_official_credential": "CADC-II QMHA BS"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "04-R-19",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CADC-II  ID NUMBER",
            "identifier": "04-R-19",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Polk County Mental Health Addiction Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Marcus L Pollard, MD
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• Addiction (Substance Use Disorder) Counselor in Salem, OR
• Providers in Salem, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2008; 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.