Roseburg Therapy LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

ROSEBURG THERAPY LLC

Practice address

272 NW Medical Loop Ste E
Roseburg, OR 97471-5545

Phone

(740) 225-5342

NPI assigned

Dec 7, 2021

Organization subpart

No

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

Authorized official

Name

Robert Josh Lydon, LCSW L7631

Title

Owner/Operator

Phone

(541) 900-4285

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1638835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638835200000",
    "number": "1477211480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "272 NW MEDICAL LOOP STE E",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974715545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "272 NW MEDICAL LOOP STE E",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974715545",
            "telephone_number": "740-225-5342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSEBURG THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-07",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A",
        "authorized_official_last_name": "LYDON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JOSH",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "541-900-4285",
        "authorized_official_credential": "LCSW L7631"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Roseburg, OR
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• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; 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.