Mimi Koontz, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L4711 Issued in OR

Practice address

550 River Rd
Eugene, OR 97404-3212

Phone

(541) 743-2611

Fax

(541) 868-0340

NPI assigned

Aug 29, 2011

Sex

Female

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

Enrolled in NC, SC2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• New Horizon Family Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Greenville, SC
  • NPI 1629872734
  NPD
• New Horizon Family Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Greenville, SC
  • NPI 1043495526
  NPD
• New Horizon Family Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Greenville, SC
  • NPI 1205949757
  NPD
• New Horizon Family Health Services Inc.

  • Federally Qualified Health Center (FQHC)
  • Greenville, SC
  • NPI 1356127021
  NPD (past)

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

{
    "created_epoch": "1314576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405382400000",
    "number": "1972884427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 RIVER RD",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974043212",
            "telephone_number": "541-743-2611",
            "fax_number": "541-868-0340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 RIVER RD",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974043212",
            "telephone_number": "541-743-2611",
            "fax_number": "541-868-0340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOONTZ",
        "first_name": "MIMI",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-29",
        "last_updated": "2014-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L4711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin Koller
• Rachael Koller
• Charles Konefal
• Kristen Konig, FNP
• Lauren Konnie, MA, LPC
• Gregory F. Koors, D.C.
• Kelly Jean Kopki
• Raymond George Kopki Sr.
• Kelly L Korach, ED. S.
• Lucas Scott Korcek, M.D.

• Clinical Social Worker in Eugene, OR
• Providers in Eugene, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.