Active NPI
Paul R Lineback, M.S., LPC, LMHC
- Professional Counselor
- Roseburg, OR
National Provider Identifier
1679765333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C1198
- Practice address
- 1299 NW Ellan St Ste 3
Roseburg, OR 97470-2031 - Phone
- (541) 391-9991
- NPI assigned
- Aug 15, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LH00004271 | WA | |
| Professional Counselor | 101YP2500X | C1198 | OR | Primary |
Addresses
Primary practice location
1299 NW Ellan St Ste 3
Roseburg, OR 97470-2031
Mailing address
PO Box 7
Roseburg, OR 97470-0001
Phone (541) 391-9991
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 Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LH00004271 | WA | MD | Mental Health Counselor |
| C1198 | OR | MD | Professional Counselor |
Interoperability endpoints
- https://api.platform.athenahealth.com/26492/brand/1/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305676800000",
"number": "1679765333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974700001",
"telephone_number": "541-391-9991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1299 NW ELLAN ST STE 3",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974702031",
"telephone_number": "541-391-9991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LINEBACK",
"first_name": "PAUL",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "M.S., LPC, LMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-15",
"last_updated": "2011-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "LH00004271",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C1198",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseburg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.