Justyn Reid Staten, CADC-I, PSS, CRM

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

21-11-10279 Issued in OR

Practice address

1333 NW 9TH St
Prineville, OR 97754-1482

Phone

(541) 447-2631

NPI assigned

Jul 26, 2022

Last updated

Sep 15, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

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

{
    "created_epoch": "1658793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663200000000",
    "number": "1851027411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1356 NW DAVENPORT AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977033077",
            "telephone_number": "541-699-9226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 NW 9TH ST",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977541482",
            "telephone_number": "541-447-2631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATEN",
        "first_name": "JUSTYN",
        "middle_name": "REID",
        "credential": "CADC-I, PSS, CRM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-26",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "21-11-10279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St. Charles Health System, Inc. (St. Charles Prineville Community Pharmacy)
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• St. Charles Health System, Inc. (St. Charles Prineville)
• St. Charles Health System, Inc. (St. Charles Prineville)
• Micalene Stafford, LMT
• Johannah Elizabeth Stephens
• Matthew V Stern, RPH
• Kseniya A Stevens, L.AC., DIPL. O.M.
• Altara Sue Stever, CADC I
• Lindsey Stewart, QMHA

• Addiction (Substance Use Disorder) Counselor in Prineville, OR
• Providers in Prineville, 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, 2022; 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.