Individual provider Active NPI

Nikki Renee Ehrmantrout, MS QMHP

  • Counselor
  • Eugene, OR
National Provider Identifier
1619043833
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
576 Olive Street Suite 307
Direction Service Counseling Center
Eugene, OR 97401
Phone
(541) 344-7303
Fax
(541) 686-6283
NPI assigned
Nov 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X Primary

Addresses

Primary practice location

576 Olive Street Suite 307
Direction Service Counseling Center
Eugene, OR 97401

Mailing address

PO Box 2101
Jasper, OR 97438
Phone (541) 726-8819

Other identifiers 1

IdentifierTypeStateIssuer
037759MedicaidOR

Other names 1

  • Nichole Renee Fulks Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240420000069 OR Practitioner - Mental Health Counselor 9133568306 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Direction Service CurrentSince Mar 1, 2024 Accepting new patients

Locations

576 Olive St
Ste 307
Eugene, OR 97401
Phone (541) 344-7303

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/directionservice/r4/

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": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619043833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2101",
            "city": "JASPER",
            "state": "OR",
            "postal_code": "97438",
            "telephone_number": "541-726-8819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "576 OLIVE STREET SUITE 307",
            "address_2": "DIRECTION SERVICE COUNSELING CENTER",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "97401",
            "telephone_number": "541-344-7303",
            "fax_number": "541-686-6283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHRMANTROUT",
        "first_name": "NIKKI",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "MS QMHP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "037759",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICHOLE",
            "last_name": "FULKS",
            "middle_name": "RENEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Eugene, OR

Sources for this page

Verify at the official NPI Registry.