NPIMap

Individual provider Active NPI

Suzanne Renee' Ark, CACDI, LPC INTERN

  • Mental Health Counselor
  • Salem, OR
National Provider Identifier
1982936464
Registry record updated Mar 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
R5063 Issued in OR
Practice address
460 Lancaster Drive NE
Salem, OR 97301
Phone
(503) 584-1906
Fax
(503) 584-1952
NPI assigned
Feb 8, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 02-03-09 OR
Addiction (Substance Use Disorder) Counselor 101YA0400X 02-03-09 OR
Addiction (Substance Use Disorder) Counselor 101YA0400X 12-06-07 OR
Mental Health Counselor 101YM0800X R5063 OR Primary

Addresses

Primary practice location

460 Lancaster Drive NE
Salem, OR 97301

Mailing address

460 Lancaster Drive NE
Salem, OR 97301
Phone (503) 584-1906

Other names 1

  • Suzanne Renee' Smith Former name

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

LicenseStateTypeSpecialty
R5063ORMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Addiction and Counseling Servcies LLC Past Accepting new patients
Center for Addiction and Counseling Services Addiction (Substance Use Disorder) Past Accepting new patients

Organizations & group practices 2

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": "1265587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522368000000",
    "number": "1982936464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 LANCASTER DRIVE NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97301",
            "telephone_number": "503-584-1906",
            "fax_number": "503-584-1952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 LANCASTER DRIVE NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97301",
            "telephone_number": "503-584-1906",
            "fax_number": "503-584-1952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARK",
        "first_name": "SUZANNE",
        "middle_name": "RENEE'",
        "name_prefix": "Mrs.",
        "credential": "CACDI, LPC INTERN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-08",
        "last_updated": "2018-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OR",
            "license": "02-03-09",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "02-03-09",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "12-06-07",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "R5063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUZANNE",
            "last_name": "SMITH",
            "middle_name": "RENEE'",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2018; 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.