Korben J Chesnut-Petry, CADC 1

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

18-02-03 Issued in OR

Practice address

1325 Commercial St SE
Salem, OR 97302-4205

Phone

(971) 301-9574

NPI assigned

Sep 15, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• CRC Health Oregon, LLC

  • Methadone Clinic
  • Salem, OR
  • NPI 1427397074
  NPD (past)
• CRC Health Oregon, LLC

  • Methadone Clinic
  • Albany, OR
  • NPI 1811561731
  NPD (past)

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600128000000",
    "number": "1841805959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 LIBERTY ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024143",
            "telephone_number": "503-391-9762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 COMMERCIAL ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024205",
            "telephone_number": "971-301-9574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHESNUT-PETRY",
        "first_name": "KORBEN",
        "middle_name": "J",
        "credential": "CADC 1",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-15",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "18-02-03",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kirstin Cheney
• Nathaniel Cheney
• Cherry City Nutrition
• Cherry Hills Neuropsychology LLC
• Cheryl Benedetto, LLC
• Jeffrey Chevalier
• Sarah Chicharro, NP
• Vitaly Chikrizov, MD
• Bryan Scott Child, MD
• Childhood Health Associates of Salem

• Addiction (Substance Use Disorder) Counselor in Salem, OR
• Providers in Salem, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; 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.