Kelly Joanne Salusova, MS, LPC
Individual provider Active NPI Professional Counselor · Estacada, OR
NPI 1710016563 · NPPES record last updated Dec 4, 2023
Key facts
- NPI
- 1710016563
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- C1743 (OR)
- Practice address
- 1018 NE Regan Hill Loop
Estacada, OR 97023-9373 - Phone
- (503) 902-1446
- NPI assigned
- Mar 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- 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 |
|---|---|---|---|---|
| I20240227002456 | OR | Practitioner - Mental Health Counselor | 7012352370 | Practice locations: Estacada, OR |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
Interoperability endpoints
- lifestancehealth.kellypeterson@148835.advancedmd-direct.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C1743 | OR | Yes |
Addresses
Primary practice location
1018 NE Regan Hill Loop
Estacada, OR 97023-9373
Mailing address
1018 NE Regan Hill Loop
Estacada, OR 97023-9373
Phone (503) 902-1446
Other names
- Mrs. Kelly Joanne Peterson
Other providers in Estacada, OR
- Jared Robert Pettit
- Andrea Lea Premazzi
- Edward Lawrence Rambousek
- Jonathan Rhue
- Justin Rye
- Ivy Seaburg
- Dana Rae Shibley
- Monica Adrian Skordilis
- Erin Caassidy Stanton
- Shileigha Dailease Stephenson
All providers in Estacada, 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 Dec 4, 2023. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.