Mary Rose Nichols, LCSW, CADCIII

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

L1978 Issued in OR

Practice address

207 SW 1St St
Enterprise, OR 97828-1203

Phone

(541) 426-4524

Fax

(541) 426-3035

NPI assigned

Jul 19, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Wallowa Valley Center for Wellness

  • Community/Behavioral Health Agency
  • Enterprise, OR
  • NPI 1043249907
  NPD (past)

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202342400000",
    "number": "1477572188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 SW 1ST ST",
            "address_2": "P.O. BOX 268",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978281203",
            "telephone_number": "541-426-4524",
            "fax_number": "541-426-3035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 SW 1ST ST",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978281203",
            "telephone_number": "541-426-4524",
            "fax_number": "541-426-3035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "MARY",
        "middle_name": "ROSE",
        "credential": "LCSW, CADCIII",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2008-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "L1978",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L1978",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210511",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randi Movich, RN
• Sean Brian Murray
• Emily Jane Nall
• Danielle Rose Nash
• Grace Claire Neuber
• Christian Niece
• Olive Branch Family Health Inc
• Sheila Orr
• Eva Oveson, QMHA
• Kelsey Anne Owens

• Addiction (Substance Use Disorder) Counselor in Enterprise, OR
• Providers in Enterprise, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2008; 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.