Individual provider Active NPI

Tracy Ann Jeffries, M.A.

  • Mental Health Counselor
  • Eugene, OR
National Provider Identifier
1598908964
Registry record updated Oct 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
R7020 Issued in OR
Practice address
1599 Oak St
Eugene, OR 97401-4008
Phone
(541) 255-1411
Fax
(541) 255-1412
NPI assigned
Apr 14, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X
Mental Health Counselor 101YM0800X R7020 OR Primary

Addresses

Primary practice location

1599 Oak St
Eugene, OR 97401-4008

Mailing address

1430 Willamette St # 140
Eugene, OR 97401-4049
Phone (541) 255-1411

Other identifiers 1

IdentifierTypeStateIssuer
500663796MedicaidOR

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
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
R7020ORMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Bridges Community Health Inc. Mental Health CurrentSince Sep 5, 2021 Accepting new patients

Locations

1599 Oak St
Eugene, OR 97401
Phone (541) 255-1411

1430 Willamette St
#140
Eugene, OR 97401

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1239667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634169600000",
    "number": "1598908964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 WILLAMETTE ST # 140",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974014049",
            "telephone_number": "541-255-1411",
            "fax_number": "541-255-1412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1599 OAK ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974014008",
            "telephone_number": "541-255-1411",
            "fax_number": "541-255-1412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEFFRIES",
        "first_name": "TRACY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-14",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "R7020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500663796",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eugene, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.