NPIMap

Individual provider Active NPI

Jack Duane Rich

  • Addiction (Substance Use Disorder) Counselor
  • Saint Helens, OR
National Provider Identifier
1477067940
Registry record updated Nov 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
090944 Issued in OR
Practice address
58147 Columbia River Hwy Ste C
Saint Helens, OR 97051-6229
Phone
(503) 396-5322
Fax
(503) 410-5678
NPI assigned
Nov 20, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2017

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 OR
Addiction (Substance Use Disorder) Counselor 101YA0400X 090944 OR Primary

Addresses

Primary practice location

58147 Columbia River Hwy Ste C
Saint Helens, OR 97051-6229

Mailing address

58147 Columbia River Hwy Ste C
Saint Helens, OR 97051-6229
Phone (503) 396-5322

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

State licenses

LicenseStateTypeSpecialty
090944ORMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

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

{
    "created_epoch": "1511136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511136000000",
    "number": "1477067940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58147 COLUMBIA RIVER HWY STE C",
            "city": "SAINT HELENS",
            "state": "OR",
            "postal_code": "970516229",
            "telephone_number": "503-396-5322",
            "fax_number": "503-410-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58147 COLUMBIA RIVER HWY STE C",
            "city": "SAINT HELENS",
            "state": "OR",
            "postal_code": "970516229",
            "telephone_number": "503-396-5322",
            "fax_number": "503-410-5678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICH",
        "first_name": "JACK",
        "middle_name": "DUANE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-20",
        "last_updated": "2017-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "090944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Helens, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2017; 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.