NPIMap

Organization Active NPI

Mid Valley Counseling Center Inc

  • Clinical Psychologist
  • Salem, OR
National Provider Identifier
1407039308
Registry record updated Jul 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
MID VALLEY COUNSELING CENTER INC
Practice address
2250 D St NE
Salem, OR 97301-2768
Phone
(503) 364-6093
Fax
(503) 364-5121
NPI assigned
Dec 13, 2007
Last updated
Jul 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2024

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

Authorized official

Name
Dr. Keith A Swanson, PSYDNPI 1245307354
Title
Secretary/Treasurer of MVCC
Phone
(503) 364-6093

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Clinical Psychologist 103TC0700X NU Primary

Addresses

Primary practice location

2250 D St NE
Salem, OR 97301-2768

Mailing address

2250 D St NE
Salem, OR 97301-2768
Phone (503) 364-6093

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, IN, CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040429000037 OR Part B Supplier - Clinic/Group Practice 2769479948 Receives reassigned benefits from 16 practitioners
Practice locations: Newberg, OR; Salem, OR
O20230525000917 IN Part B Supplier - Clinic/Group Practice 2769479948 Receives reassigned benefits from 1 practitioner
Practice locations: Crown Point, IN
O20231011002878 CA Part B Supplier - Clinic/Group Practice 2769479948 Receives reassigned benefits from 1 practitioner
Practice locations: Ventura, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1197504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719878400000",
    "number": "1407039308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 D ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973012768",
            "telephone_number": "503-364-6093",
            "fax_number": "503-364-5121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2250 D ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973012768",
            "telephone_number": "503-364-6093",
            "fax_number": "503-364-5121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID VALLEY COUNSELING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-13",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A",
        "authorized_official_last_name": "SWANSON",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SECRETARY/TREASURER OF MVCC",
        "authorized_official_telephone_number": "503-364-6093",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.