Community Roots Counseling, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

COMMUNITY ROOTS COUNSELING, LLC

Practice address

494 State St Ste 270
Salem, OR 97301-3647

Phone

(503) 583-2121

Fax

(855) 855-4872

NPI assigned

Aug 8, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Jes Dimas, LCSW, LICSW, LSSW

Title

Therapist and Founder

Phone

(503) 583-2121

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1596844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694476800000",
    "number": "1417567983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5312",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973040312",
            "telephone_number": "503-583-2121",
            "fax_number": "855-855-4872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "494 STATE ST STE 270",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013647",
            "telephone_number": "503-583-2121",
            "fax_number": "855-855-4872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY ROOTS COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-08",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A",
        "authorized_official_last_name": "DIMAS",
        "authorized_official_first_name": "JES",
        "authorized_official_title_or_position": "THERAPIST AND FOUNDER",
        "authorized_official_telephone_number": "503-583-2121",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW, LICSW, LSSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500688776",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Salem, OR
• Providers in Salem, OR by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; 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.