John Liam Connelly, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

200 Beatty St
Medford, OR 97501-5811

Phone

(541) 476-2373

NPI assigned

Sep 5, 2022

Last updated

Nov 8, 2023By the provider in NPPES

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rising Phoenix Counseling Services, LLC

  • Mental Health Counselor
  • Medford, OR
  • NPI 1164952164
  NPD (past)

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

{
    "created_epoch": "1662336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1942921382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 SW G ST",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975262544",
            "telephone_number": "541-476-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BEATTY ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975015811",
            "telephone_number": "541-476-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELLY",
        "first_name": "JOHN",
        "middle_name": "LIAM",
        "name_prefix": "Mr.",
        "credential": "NCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-05",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Alyse Conley, LMT
• Kathleen Marie Connair-Rau, PEER SUPPORT SPEC
• Connected Physical Therapy
• Heather Kathleen Connell
• Caroline L Connelly, FNP
• Denise Conner, RN
• Shara Ann Conner
• Sean Michael Connolly, B.S
• Lawrence Christopher Conover, PAC
• Jody Lee Conrad

• Mental Health Counselor in Medford, OR
• Providers in Medford, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; 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.