Active NPI
Gizella Luccio, CADC II & QMHP-C
- Addiction (Substance Use Disorder) Counselor
- Medford, OR
National Provider Identifier
1306140298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 12-09-620
- Practice address
- 328 S. Central Ave, Suite 212
Medford, OR 97501 - Phone
- (541) 944-0748
- Fax
- (541) 482-6462
- NPI assigned
- Jan 6, 2011
- 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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Mental Health Counselor | 101YM0800X | 19-QMNPC-00730 | OR | |
| Pastoral Counselor | 101YP1600X | M.A.T.S. | CA | |
| Behavior Analyst | 103K00000X | 819261 | OR | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 12-09-620 | OR | Primary |
Addresses
Primary practice location
328 S. Central Ave, Suite 212
Medford, OR 97501
Mailing address
165 Taylor Ave.
Talent, OR 97540
Phone (541) 944-0748
Other names 1
- Gabrielle Adele Leslie
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
| License | State | Type | Specialty |
|---|---|---|---|
| 19-QMNPC-00730 | OR | MD | Mental Health Counselor |
| M.A.T.S. | CA | MD | Pastoral Counselor |
| 819261 | OR | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648252800000",
"number": "1306140298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 TAYLOR AVE.",
"city": "TALENT",
"state": "OR",
"postal_code": "97540",
"telephone_number": "541-944-0748",
"fax_number": "541-779-3317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "328 S. CENTRAL AVE, SUITE 212",
"city": "MEDFORD",
"state": "OR",
"postal_code": "97501",
"telephone_number": "541-944-0748",
"fax_number": "541-482-6462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCCIO",
"first_name": "GIZELLA",
"name_prefix": "Ms.",
"credential": "CADC II & QMHP-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-06",
"last_updated": "2022-03-26",
"certification_date": "2022-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "19-QMNPC-00730",
"primary": false
},
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": "CA",
"license": "M.A.T.S.",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "OR",
"license": "819261",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "12-09-620",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "GABRIELLE",
"last_name": "LESLIE",
"middle_name": "ADELE",
"credential": "CADC II & QMHP-C",
"code": "1",
"type": "Former Name"
}
]
}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 Mar 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.