Brandy Lynn Blackwell, CADC 1
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Coburg, OR
NPI 1639716525 · NPPES record last updated Dec 10, 2019
Key facts
- NPI
- 1639716525
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 19-P-15 (OR)
- Practice address
- 91150 N Coburg Industrial Way
Coburg, OR 97408-1313 - Phone
- (541) 284-5673
- NPI assigned
- Dec 10, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19-P-15 | OR | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Serenity Lane | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 19-P-15 | OR | Yes |
Addresses
Primary practice location
91150 N Coburg Industrial Way
Coburg, OR 97408-1313
Mailing address
PO Box 8549
Coburg, OR 97408-1313
Phone (541) 284-5673
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104934892 | Other | OR | NPI |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | bblackwell@serenitylane.org |
Other providers in Coburg, OR
- Emily Ann Baldwin
- Maranda D Barlow
- Alisha Marie Bashor
- Daniel John Bates I
- Jason Bernal
- Sharon Mary Blanchard
- Kenneth Boggie
- Hannah Boissier
- Christopher Bowling
- Mark Brauer
All providers in Coburg, OR · Addiction (Substance Use Disorder) Counselor in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.