Active NPI
Jacalyn Rose McKenzie, CADC CANDIDATE
- Addiction (Substance Use Disorder) Counselor
- Prineville, OR
National Provider Identifier
1528554151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- T-18-076
- Practice address
- 1333 NW 9TH St
Prineville, OR 97754-1482 - Phone
- (541) 447-2631
- Fax
- (541) 447-2616
- NPI assigned
- Jul 6, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | T-18-076 | OR | Primary |
Addresses
Primary practice location
1333 NW 9TH St
Prineville, OR 97754-1482
Mailing address
1333 NW 9TH St
Prineville, OR 97754-1482
Phone (541) 447-2631
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
| License | State | Type | Specialty |
|---|---|---|---|
| T-18-076 | OR | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530835200000",
"number": "1528554151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1333 NW 9TH ST",
"city": "PRINEVILLE",
"state": "OR",
"postal_code": "977541482",
"telephone_number": "541-447-2631",
"fax_number": "541-447-2616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1333 NW 9TH ST",
"city": "PRINEVILLE",
"state": "OR",
"postal_code": "977541482",
"telephone_number": "541-447-2631",
"fax_number": "541-447-2616"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKENZIE",
"first_name": "JACALYN",
"middle_name": "ROSE",
"credential": "CADC CANDIDATE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-06",
"last_updated": "2018-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "T-18-076",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prineville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.