Jacqualyn Rae Andrews, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C5956 Issued in OR

Practice address

210 S 5TH St
Cottage Grove, OR 97424-2105

Phone

(541) 255-1411

Fax

(541) 255-1412

NPI assigned

Aug 10, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Bridges Community Health Inc.

  • Mental Health Counselor
  • Cottage Grove, OR
  • NPI 1093249542
  NPD

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

{
    "created_epoch": "1597017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685923200000",
    "number": "1801407259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 WILLAMETTE STREET, SUITE 301, #140",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974014593",
            "telephone_number": "541-255-1411",
            "fax_number": "541-255-1412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S 5TH ST",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974242105",
            "telephone_number": "541-255-1411",
            "fax_number": "541-255-1412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDREWS",
        "first_name": "JACQUALYN",
        "middle_name": "RAE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-10",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OR",
            "license": "C5956",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C5956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500787676",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Agape Integrative Psychiatry and Wellness, LLC
• Jessica Lea Aguilar Flores, LMT
• Elizabeth Davis Akers, QMHP
• Johanna R. Anderson, QMHP
• Kathryn Elizabeth Anderson, PHARMD
• Rachel Andrews
• Holly Arbuckle, L.AC
• Kathleen Marie Arp, CHW
• Brandy Ashwood, QMHP
• Aspen Chiropractic and Health Center P.C.

• Mental Health Counselor in Cottage Grove, OR
• Providers in Cottage Grove, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; 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.