Glenn Taylor Brasington, PH.D.
Individual provider Active NPI Counseling Psychologist · Silverton, OR
NPI 1780697144 · NPPES record last updated Jul 14, 2009
Key facts
- NPI
- 1780697144
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counseling Psychologist 103TC1900X
- License
- 856 (OR)
- Practice address
- 429 N Water St
Silverton, OR 97381-1645 - Phone
- (503) 310-9157
- Fax
- (503) 873-6340
- NPI assigned
- Aug 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1979
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
429 N Water St
Silverton, OR 97381-1645
Phone (503) 310-9157
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 |
|---|---|---|---|---|
| I20090915000658 | OR | Practitioner - Clinical Psychologist | 8820144975 | Practice locations: Salem, OR; Silverton, OR |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 211 | HI | MD | Behavioral Analyst |
| 856 | OR | MD | Counseling Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Branches of Change Counseling LLC | Past |
Accepting new patients | |
| An Inner Guide LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 856 | OR | Yes |
| Counseling Psychologist | 103TC1900X | 211 | HI |
Addresses
Primary practice location
429 N Water St
Silverton, OR 97381-1645
Mailing address
PO Box 962
Silverton, OR 97381-0962
Phone (503) 310-9157
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R000TCHMF | Other | OR | MEDICARE-TYPE UNSPECIFIED |
Other providers in Silverton, OR
- Joseph Bochsler
- Rayanna R Boltman
- Alfred M Borromeo
- Martin Robert Box
- Lewis S Bradshaw
- Nathan C Braxmeyer
- Jody Brehm
- Paul Andrew Brewer
- Breiana Brooks
- Brooks' Wellness Massage LLC
All providers in Silverton, OR · Counseling Psychologist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2009. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.