Active NPI
Kelsey Danielle Leroy Gomez
- Mental Health Counselor
- Roseburg, OR
National Provider Identifier
1457615353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 621 W Madrone St
Roseburg, OR 97470-3090 - Phone
- (541) 440-3532
- NPI assigned
- Jun 26, 2012
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | |||
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
621 W Madrone St
Roseburg, OR 97470-3090
Mailing address
PO Box 1121
Roseburg, OR 97470-0254
Other practice location 1
272 NW Medical Loop
Suite C
Roseburg, OR 97471-5597
Phone (541) 440-3532
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500663439 | Medicaid | OR |
Other names 1
- Kelsey Danielle Leroy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roseburg Clinic, P.C. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Otolaryngology Physician
- Roseburg, OR
- NPI 1841396405
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751414400000",
"number": "1457615353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1121",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974700254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "621 W MADRONE ST",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974703090",
"telephone_number": "541-440-3532"
}
],
"practiceLocations": [
{
"address_1": "272 NW Medical Loop",
"address_2": "Suite C",
"address_purpose": "LOCATION",
"city": "Roseburg",
"state": "OR",
"postal_code": "974715597",
"country_code": "US",
"telephone_number": "541-440-3532",
"fax_number": "541-440-3554",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEROY GOMEZ",
"first_name": "KELSEY",
"middle_name": "DANIELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-26",
"last_updated": "2025-07-02",
"certification_date": "2025-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500663439",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KELSEY",
"last_name": "LEROY",
"middle_name": "DANIELLE",
"code": "1",
"type": "Former Name"
}
]
}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 Jul 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.