| Rogue Psych Consultants, Llc | |
|
835 Crater Lake Ave Medford OR 97504-6505 | |
| (541) 500-8655 | |
| (800) 433-1396 |
| Full Name | Rogue Psych Consultants, Llc |
|---|---|
| Speciality | Counselor |
| Location | 835 Crater Lake Ave, Medford, Oregon |
| Authorized Official Name and Position | Evan Alvord (SOLE MEMBER) |
| Authorized Official Contact | 5415008655 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rogue Psych Consultants, Llc Po Box 1787 Medford OR 97501-0261 Ph: (541) 500-8655 | Rogue Psych Consultants, Llc 835 Crater Lake Ave Medford OR 97504-6505 Ph: (541) 500-8655 |
| NPI Number | 1447727110 |
|---|---|
| Provider Enumeration Date | 10/31/2018 |
| Last Update Date | 11/08/2022 |
| Certification Date | 11/08/2022 |
| Medicare PECOS PAC ID | 1850632415 |
|---|---|
| Medicare Enrollment ID | O20190408002460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447727110 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kacy Lynn Mullen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801224795 PECOS PAC ID: 1355567660 Enrollment ID: I20140723000295 |
| Provider Name | Susan K Ryan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750602579 PECOS PAC ID: 9335464569 Enrollment ID: I20150211000756 |
| Provider Name | Tara Lee Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669802161 PECOS PAC ID: 8325330483 Enrollment ID: I20170421000330 |
| Provider Name | Betty Louise Wagner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720132129 PECOS PAC ID: 6709139090 Enrollment ID: I20181114002263 |
| Provider Name | Kathryn Clements |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750555249 PECOS PAC ID: 2264697465 Enrollment ID: I20190328002487 |
| Provider Name | Evan Matthew Alvord |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720224553 PECOS PAC ID: 2769723329 Enrollment ID: I20190408002601 |
| Provider Name | Amy Kathleen Twiest |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689862740 PECOS PAC ID: 2062749518 Enrollment ID: I20190807001165 |
| Provider Name | Nadejda Ioana Razi Robertson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366899445 PECOS PAC ID: 5799178190 Enrollment ID: I20220208000607 |
| Provider Name | Nicole Hoagland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386019248 PECOS PAC ID: 7416340567 Enrollment ID: I20220214000127 |
| Provider Name | Matthew Thomas Blakeley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457659948 PECOS PAC ID: 2860868585 Enrollment ID: I20221021000506 |
| Provider Name | Benjamin Lee Giesbrecht |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417277211 PECOS PAC ID: 0143697078 Enrollment ID: I20221107002391 |
| Provider Name | Sarah Weis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750779369 PECOS PAC ID: 1557730934 Enrollment ID: I20221206003086 |
| Provider Name | Amber Brand |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730308636 PECOS PAC ID: 8628441862 Enrollment ID: I20230308002534 |
| Provider Name | Jason Wilcox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225280753 PECOS PAC ID: 6709251093 Enrollment ID: I20230419002003 |
| Provider Name | Courtney Rene Cooper |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093951832 PECOS PAC ID: 3678931078 Enrollment ID: I20230616000799 |
| Provider Name | Danielle Sharayah Barth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417392366 PECOS PAC ID: 6103288808 Enrollment ID: I20230811002297 |
| Provider Name | Mollie Brynne Baker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225561582 PECOS PAC ID: 2567815368 Enrollment ID: I20240129001520 |
| Provider Name | Tara Linnea Weldon |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1679959621 PECOS PAC ID: 5890130181 Enrollment ID: I20240226004184 |
| Provider Name | Leslie Ramage |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003670365 PECOS PAC ID: 9537504162 Enrollment ID: I20240305001598 |
| Provider Name | Kimberli Ann Wicks |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649487927 PECOS PAC ID: 6204275019 Enrollment ID: I20240412002234 |
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