Mary M Elsethagen, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

101 NW Boardman Ave.
Boardman, OR 97818

Phone

(541) 481-2911

NPI assigned

Jul 30, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Community Counseling Solutions

  • Rural Health Clinic/Center
  • John Day, OR
  • NPI 1487992665

  OR

  Medicare reassignment NPD
• Community Counseling Solutions

  • Addiction (Substance Use Disorder) Counselor
  • Heppner, OR
  • NPI 1578501771

  Mental Health

  NPD
• Grant County

  • Family Nurse Practitioner
  • John Day, OR
  • NPI 1629009022
  NPD
• Heather a Bacon, PH.D., LLC

  • Clinical Psychologist
  • Hermiston, OR
  • NPI 1447845458
  NPD (past)

Specialty

Undefined Non-Physician Type (Specify)

Education

Other, 1998

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257292800000",
    "number": "1336154012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3002 S EDISON PL",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993382714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NW BOARDMAN AVE.",
            "city": "BOARDMAN",
            "state": "OR",
            "postal_code": "97818",
            "telephone_number": "541-481-2911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELSETHAGEN",
        "first_name": "MARY",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-30",
        "last_updated": "2009-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPC",
            "identifier": "C1782",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sonja Daniels
• Karla Davison
• Karla Ayde Dominguez, PEER SUPPORT
• Colleen Sonja Drake
• Andrea Dunlap
• Eopt Boardman PLLC
• Toni Findling
• Tiffany Gerard
• Alexis Goff
• Good Shepherd Medical Service Corp

• All providers in Boardman, OR
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2009; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.