Active NPI
Mataji Allen, LPC
- Mental Health Counselor
- Medford, OR
National Provider Identifier
1811291164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 300 W Main St
Medford, OR 97501-2756 - Phone
- (541) 772-1777
- Fax
- (541) 724-2410
- NPI assigned
- Dec 30, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | C5074 | OR | |
| Professional Counselor | 101YP2500X | C5074 | OR | |
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
300 W Main St
Medford, OR 97501-2756
Mailing address
300 W Main St
Medford, OR 97501-2756
Phone (541) 772-1777
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C5074 | OR | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Jackson | Current | Accepting new patients |
Locations
140 S Holly St
Medford, OR 97501
Phone (541) 774-8200
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 Clinic/Center (Including Community Mental Health Center)
- Medford, OR
- NPI 1710933379
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1293667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696896000000",
"number": "1811291164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W MAIN ST",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975012756",
"telephone_number": "541-772-1777",
"fax_number": "541-724-2410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W MAIN ST",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975012756",
"telephone_number": "541-772-1777",
"fax_number": "541-724-2410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLEN",
"first_name": "MATAJI",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-30",
"last_updated": "2023-10-10",
"certification_date": "2023-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "C5074",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C5074",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.