Cheryl Anne Gifford, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1309 Issued in OR

Practice address

1 Serenity LN
Coburg, OR 97408-9350

Phone

(541) 687-1110

Fax

(541) 687-9041

NPI assigned

Aug 31, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lgbtq Telepsychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Sheridan, WY
  • NPI 1336722859

  OR

  Medicare reassignment Care Compare group NPD
• Serenity Lane

  • Substance Abuse Rehabilitation Facility
  • Coburg, OR
  • NPI 1467283069
  NPD
• Serenity Lane

  • Substance Abuse Rehabilitation Facility
  • Coburg, OR
  • NPI 1104934892
  NPD (past)

Specialty

Clinical Psychologist

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lgbtq Telepsychiatry 17 clinicians

Practice addresses (Care Compare)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1720072044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SERENITY LN",
            "city": "COBURG",
            "state": "OR",
            "postal_code": "974089350",
            "telephone_number": "541-687-1110",
            "fax_number": "541-687-9041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SERENITY LN",
            "city": "COBURG",
            "state": "OR",
            "postal_code": "974089350",
            "telephone_number": "541-687-1110",
            "fax_number": "541-687-9041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIFFORD",
        "first_name": "CHERYL",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-31",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181430",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BCBS PROV. #",
            "identifier": "825411000",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFICSOURCE INS. PROV.",
            "identifier": "J6460 01",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Fullmer
• Karine Garabedian, PSS, CRM, CADC-R
• Delilah Garza
• Tashina Rae Gibbins, CADC-R
• Emily Elise Gibson, CADC I
• Shawna Ruth Gillespie
• Douglas Gomez, PHD
• Claire Gosslee
• Alissa Hallock
• Noor Hamdy

• All providers in Coburg, OR
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.