Jacey Ellen Riedl, LPC-INTERN

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C7786 Issued in OR

Practice address

Blissful Heart Wellness Center
29 NW Greeley Avenue
Bend, OR 97703-5414

Phone

(303) 868-5241

NPI assigned

Jul 19, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Jacey Smith Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1568035525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2145 NW TWILIGHT DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977035414",
            "telephone_number": "303-868-5241",
            "fax_number": "541-639-8107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLISSFUL HEART WELLNESS CENTER",
            "address_2": "29 NW GREELEY AVENUE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977035414",
            "telephone_number": "303-868-5241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIEDL",
        "first_name": "JACEY",
        "middle_name": "ELLEN",
        "credential": "LPC-INTERN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-19",
        "last_updated": "2023-12-01",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "R6395",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C7786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACEY",
            "last_name": "SMITH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sarah Imel Richter, NP
• Cristin C Ricker, PAC
• Ian C Riddock, M.D.
• Will F Rieder
• Madison Riedford, DPT
• Deborah Lenore Rief-Adams, FNP
• Ashley Elizabeth Rieger, ND
• Ries Chiropractic Center PC
• Darrel Ray Ries, D.C.
• Susan E Rife, RN

• Professional Counselor in Bend, OR
• Providers in Bend, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; 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.