Active NPI
Susan Desantis Marion, LPC
- Professional Counselor
- Medford, OR
National Provider Identifier
1902101066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C1923
- Practice address
- 1005 East Main Street
Jackson County Mental Health
Medford, OR 97504 - Phone
- (541) 774-7890
- Fax
- (541) 774-7981
- NPI assigned
- Jan 21, 2011
- Last updated
- Jan 21, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C1923 | OR | Primary |
Addresses
Primary practice location
1005 East Main Street
Jackson County Mental Health
Medford, OR 97504
Mailing address
1005 East Main St.
Jackson County Mental Health
Medford, OR 97504
Phone (541) 774-7890
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
| License | State | Type | Specialty |
|---|---|---|---|
| C1923 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295568000000",
"number": "1902101066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1005 EAST MAIN ST.",
"address_2": "JACKSON COUNTY MENTAL HEALTH",
"city": "MEDFORD",
"state": "OR",
"postal_code": "97504",
"telephone_number": "541-774-7890",
"fax_number": "541-774-7981"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1005 EAST MAIN STREET",
"address_2": "JACKSON COUNTY MENTAL HEALTH",
"city": "MEDFORD",
"state": "OR",
"postal_code": "97504",
"telephone_number": "541-774-7890",
"fax_number": "541-774-7981"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARION",
"first_name": "SUSAN",
"middle_name": "DESANTIS",
"name_prefix": "Ms.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-21",
"last_updated": "2011-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C1923",
"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 Jan 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.