Gina Marie Allison, LPC
Individual provider Active NPI Professional Counselor · Bandon, OR
NPI 1669787115 · NPPES record last updated Aug 9, 2010
Key facts
- NPI
- 1669787115
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- C2507 (OR)
- Practice address
- 390 1St St SW
Suite 2B
Bandon, OR 97411-4500 - Phone
- (541) 329-0555
- NPI assigned
- Aug 9, 2010
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Coquille Indian Tribe
Practice addresses (Care Compare)
630 Miluk Dr
Coos Bay, OR 97420-7728
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240324000079 | OR | Practitioner - Mental Health Counselor | 3072950278 | Reassigns benefits to 1 organization |
| I20260318000264 | TX | Practitioner - Mental Health Counselor | 3072950278 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 636 | AK | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coquille Indian Tribe | Current |
Accepting new patients |
Locations
630 Miluk Dr
Coos Bay, OR 97420
Phone (541) 756-0904
Interoperability endpoints
- gina.allison.p2@direct.coquilletribe.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C2507 | OR | Yes |
| Professional Counselor | 101YP2500X | 636 | AK |
Addresses
Primary practice location
390 1St St SW
Suite 2B
Bandon, OR 97411-4500
Mailing address
PO Box 1387
Bandon, OR 97411-1387
Phone (541) 329-0555
Other providers in Bandon, OR
- Adapt
- Adapt
- Advantage Dental Group, PC
- Suzanne Marie Alexander
- Mary Nell Anker
- Bandon Chiropractic
- Bandon Coastal Dental, LLC
- Bandon Community Health Center
- Bandon Family Medicine, LLC
All providers in Bandon, OR · Professional 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 Aug 9, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.