Individual provider Active NPI

Codie Wilson

  • Mental Health Counselor
  • Springfield, OR
National Provider Identifier
1396239901
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
PROFESSIONALLICENSE
Practice address
1705 Centennial Blvd Ste 2
Springfield, OR 97477-3320
Phone
(541) 818-0009
NPI assigned
Jun 18, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Mental Health Counselor 101YM0800X PROFESSIONALLICENSE Primary

Addresses

Primary practice location

1705 Centennial Blvd Ste 2
Springfield, OR 97477-3320

Mailing address

1705 Centennial Blvd Ste 2
Springfield, OR 97477-3320
Phone (584) 818-0009

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250906000768 OR Practitioner - Mental Health Counselor 0042712242 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1320 Mayes Rd
Toccoa, GA 30577-6761

242 W Savage Ave
Saratoga Springs, UT 84045-6454

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Directions, LLC CurrentSince Jan 29, 2023 Accepting new patients
Oregon Directions, LLC Mental Health CurrentSince Jun 25, 2025 Accepting new patients
Columbiacare Services Past Accepting new patients

Locations

1705 Centennial Blvd
Ste 2
Springfield, OR 97477
Phone (970) 962-4819

1705 Centennial Blvd
Ste 12
Springfield, OR 97477

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1529280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1396239901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 CENTENNIAL BLVD STE 2",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974773320",
            "telephone_number": "584-818-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 CENTENNIAL BLVD STE 2",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974773320",
            "telephone_number": "541-818-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CODIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-18",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": "PROFESSIONALLICENSE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OR

Sources for this page

Verify at the official NPI Registry.