Individual provider Active NPI

Thalia Davies Brennan, LPC

  • Mental Health Counselor
  • Klamath Falls, OR
National Provider Identifier
1811280639
Registry record updated Sep 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
C4850 Issued in OR
Practice address
2074 S 6TH St
Klamath Falls, OR 97601-3372
Phone
(541) 851-8110
NPI assigned
May 26, 2011
Last updated
Sep 24, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 7304 NC
Mental Health Counselor 101YM0800X C4850 OR Primary

Addresses

Primary practice location

2074 S 6TH St
Klamath Falls, OR 97601-3372

Mailing address

2074 S 6TH St
Klamath Falls, OR 97601-3372
Phone (541) 851-8110

Other practice location 1

194 Junco Ln
Brevard, NC 28712-9824
Phone (828) 553-6873

Other identifiers 1

IdentifierTypeStateIssuer
170061MedicaidOR

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

LicenseStateTypeSpecialty
C4850ORMDMental Health Counselor
7304NCMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1306368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537747200000",
    "number": "1811280639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2074 S 6TH ST",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976013372",
            "telephone_number": "541-851-8110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2074 S 6TH ST",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976013372",
            "telephone_number": "541-851-8110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "194 Junco Ln",
            "address_purpose": "LOCATION",
            "city": "Brevard",
            "state": "NC",
            "postal_code": "287129824",
            "country_code": "US",
            "telephone_number": "828-553-6873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRENNAN",
        "first_name": "THALIA",
        "middle_name": "DAVIES",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-26",
        "last_updated": "2018-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "7304",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C4850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170061",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Klamath Falls, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; 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.