Individual provider Active NPI

Lori G Kloss

  • Professional Counselor
  • Albany, OR
National Provider Identifier
1871146316
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
C7299 Issued in OR
Practice address
2225 Pacific Blvd SE
Albany, OR 97321-7907
Phone
(541) 321-2278
Fax
(541) 249-8826
NPI assigned
Jul 23, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

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 C7299 OR
Professional Counselor 101YP2500X C7299 OR Primary

Addresses

Primary practice location

2225 Pacific Blvd SE
Albany, OR 97321-7907

Mailing address

4585 SW 185TH Ave
Aloha, OR 97078-1557

Other identifiers 1

IdentifierTypeStateIssuer
500771153MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240216000880 OR Practitioner - Mental Health Counselor 0749635266 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tabula Rasa Wellness LLCGroup PAC ID 0941676662, 3 clinicians

Practice addresses (Care Compare)

960 Broadway St NE
Suite 3
Salem, OR 97301-1275
Phone (503) 967-3428

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C7299ORMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Aronoff Counseling LLC Professional CurrentSince Jan 1, 2024 Accepting new patients
Tabula Rasa Wellness LLC CurrentSince Jun 22, 2024 Accepting new patients
Arise Counseling Service, LLC. Dba Northlight Counseling Professional PastSince Nov 1, 2020 Accepting new patients

Locations

61396 S Highway 97
Ste 224
Bend, OR 97702
Phone (503) 967-3428

960 Broadway St NE
Ste 3
Salem, OR 97301
Phone (503) 489-4747

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1871146316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4585 SW 185TH AVE",
            "city": "ALOHA",
            "state": "OR",
            "postal_code": "970781557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 PACIFIC BLVD SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973217907",
            "telephone_number": "541-321-2278",
            "fax_number": "541-249-8826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOSS",
        "first_name": "LORI",
        "middle_name": "G",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-23",
        "last_updated": "2024-11-04",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C7299",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C7299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500771153",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, OR

Sources for this page

Verify at the official NPI Registry.