NPIMap

Organization Active NPI

Umpqua Counseling PC

  • Psychiatric/Mental Health Clinical Nurse Specialist
  • Roseburg, OR
National Provider Identifier
1346354446
Registry record updated Aug 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X
Legal business name
UMPQUA COUNSELING PC
Practice address
770 SE Kane St
Roseburg, OR 97470-3943
Phone
(541) 673-0057
Fax
(541) 673-2270
NPI assigned
Aug 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2007

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

Authorized official

Name
Mr. Ken Serkownek, PH.D
Title
Owner
Phone
(541) 673-0057

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X OR
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X OR
Psychiatric/Mental Health Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364SP0808X OR Primary

Addresses

Primary practice location

770 SE Kane St
Roseburg, OR 97470-3943

Mailing address

770 SE Kane St
Roseburg, OR 97470-3943
Phone (541) 673-0057

Other names 1

  • Umpqua counseling Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187827200000",
    "number": "1346354446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 SE KANE ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974703943",
            "telephone_number": "541-673-0057",
            "fax_number": "541-673-2270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 SE KANE ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974703943",
            "telephone_number": "541-673-0057",
            "fax_number": "541-673-2270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UMPQUA COUNSELING PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2007-08-23",
        "status": "A",
        "authorized_official_last_name": "SERKOWNEK",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-673-0057",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Umpqua counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roseburg, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2007; 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.