Active NPI
Nicole Spreadborough
- Professional Counselor
- Bend, OR
National Provider Identifier
1376833012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C3071
- Practice address
- 2542 NE Courtney Dr
Bend, OR 97701-7685 - Phone
- (541) 706-2768
- Fax
- (541) 706-4760
- NPI assigned
- Apr 14, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Professional Counselor | 101YP2500X | C3071 | OR | Primary |
Addresses
Primary practice location
2542 NE Courtney Dr
Bend, OR 97701-7685
Mailing address
PO Box 5579
Bend, OR 97708-5579
Phone (541) 706-2768
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C3071 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458259200000",
"number": "1376833012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5579",
"city": "BEND",
"state": "OR",
"postal_code": "977085579",
"telephone_number": "541-706-2768",
"fax_number": "541-706-4760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2542 NE COURTNEY DR",
"city": "BEND",
"state": "OR",
"postal_code": "977017685",
"telephone_number": "541-706-2768",
"fax_number": "541-706-4760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPREADBOROUGH",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-14",
"last_updated": "2016-03-18",
"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": "OR",
"license": "C3071",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2016; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.