MEDICARE: ADAPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261Q00000X	Clinic/Center
3	261QM0850X	Adult Mental Health Clinic/Center
4	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154502052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAPT

Provider Business Mailing Address
First Line	:	PO BOX 1121
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-0254
Country	:	US
Telephone Number	:	541-672-2691
Fax Number	:	541-673-5642

Provider Business Practice Location Address
First Line	:	400 VIRGINIA AVE
Second Line	:	SUITE 201
City	:	NORTH BEND
State	:	OR
Zip	:	97459-3477
Country	:	US
Telephone Number	:	541-751-0357
Fax Number	:	541-751-9985

Authorized Official
Title or Position	:	CEO
Name	:	MR. BRUCE PIPER
Credential	:
Telephone Number	:	541-672-2691

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	11/10/2022

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Directions to “ADAPT ” Practice Location

Language	Start Address	Practice Location

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