Active NPI
John Bryan Wilson, QHMP
- Mental Health Counselor
- Bend, OR
National Provider Identifier
1679297816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 22-QHMP-R-1539
- Practice address
- 20370 Poe Sholes Dr
Bend, OR 97703-7938 - Phone
- (541) 318-1377
- Fax
- (541) 383-4587
- NPI assigned
- Sep 30, 2022
- Last updated
- Sep 30, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 22-QHMP-R-1539 | OR | Primary |
Addresses
Primary practice location
20370 Poe Sholes Dr
Bend, OR 97703-7938
Mailing address
20370 Poe Sholes Dr
Bend, OR 97703-7938
Phone (541) 318-1377
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22-QHMP-R-1539 | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664496000000",
"number": "1679297816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20370 POE SHOLES DR",
"city": "BEND",
"state": "OR",
"postal_code": "977037938",
"telephone_number": "541-318-1377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20370 POE SHOLES DR",
"city": "BEND",
"state": "OR",
"postal_code": "977037938",
"telephone_number": "541-318-1377",
"fax_number": "541-383-4587"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JOHN",
"middle_name": "BRYAN",
"credential": "QHMP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-30",
"last_updated": "2022-09-30",
"certification_date": "2022-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "22-QHMP-R-1539",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.