Active NPI
Michael Bryan Tripp Sr., LMT
- Contractor
- Cottage Grove, OR
National Provider Identifier
1730366998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 11018
- Practice address
- 411 Washington Ave
Cottage Grove, OR 97424-2060 - Phone
- (541) 554-7027
- Fax
- (541) 942-9849
- NPI assigned
- Jan 29, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 11018 | OR | Primary |
Addresses
Primary practice location
411 Washington Ave
Cottage Grove, OR 97424-2060
Mailing address
411 Washington Ave
Cottage Grove, OR 97424-2060
Phone (541) 554-7027
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 |
|---|---|---|---|
| 11018 | OR | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cottage Grove Counseling Clinic, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Counselor
- Cottage Grove, OR
- NPI 1023138088
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201564800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201564800000",
"number": "1730366998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 WASHINGTON AVE",
"city": "COTTAGE GROVE",
"state": "OR",
"postal_code": "974242060",
"telephone_number": "541-554-7027",
"fax_number": "541-942-9849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 WASHINGTON AVE",
"city": "COTTAGE GROVE",
"state": "OR",
"postal_code": "974242060",
"telephone_number": "541-554-7027",
"fax_number": "541-942-9849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRIPP",
"first_name": "MICHAEL",
"middle_name": "BRYAN",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-29",
"last_updated": "2008-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "OR",
"license": "11018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cottage Grove, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.