Tracy Renee Adevai, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L10899 Issued in OR

Practice address

285 SE Fowler St
Roseburg, OR 97470-3337

Phone

(541) 671-5185

Fax

(541) 230-2575

NPI assigned

Jul 25, 2014

Last updated

Mar 2, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Collidng Rivers Counseling Services, LLC Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1406246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709337600000",
    "number": "1740698471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 375",
            "city": "GLIDE",
            "state": "OR",
            "postal_code": "974430375",
            "telephone_number": "541-671-5185",
            "fax_number": "541-230-2575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 SE FOWLER ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974703337",
            "telephone_number": "541-671-5185",
            "fax_number": "541-230-2575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEVAI",
        "first_name": "TRACY",
        "middle_name": "RENEE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-25",
        "last_updated": "2024-03-02",
        "certification_date": "2024-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L10899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500685947",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLIDNG RIVERS",
            "last_name": "SERVICES, LLC",
            "middle_name": "COUNSELING",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Advanced Sleep Health, LLC
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• Diwaker Agarwal, MD
• Kanan Rahul Agarwal, PHARMD
• Tosha Agee

• Clinical Social Worker in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.