{"npi":"1104401439","type":"NPI-2","status":"active","name":{"display":"Umpqua Family Therapy LLC","other":[],"organization_name":"UMPQUA FAMILY THERAPY LLC","authorised_official":"Meredith Concepcion"},"specialty":{"primary_taxonomy":"261QM0801X","primary_taxonomy_description":"Mental Health Clinic/Center (Including Community Mental Health Center)","slug":"mental-health-clinic-center-including-community-mental-health-center","schema_org_specialty":null,"all":[{"code":"251B00000X","description":"Case Management Agency","primary":false,"state":null,"license":null},{"code":"261QM0855X","description":"Adolescent and Children Mental Health Clinic/Center","primary":false,"state":null,"license":null},{"code":"261QM0801X","description":"Mental Health Clinic/Center (Including Community Mental Health Center)","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"1299 NW ELLAN ST STE 2","city":"ROSEBURG","state":"OR","postal_code":"974702031","country_code":"US","phone":"4588023883","fax":"5419001840"},{"purpose":"MAILING","street_1":"1299 NW ELLAN ST STE 2","city":"ROSEBURG","state":"OR","postal_code":"974702031","country_code":"US","phone":"4588023883","fax":"5419001840"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"14105272","state":"OR","issuer":null},{"type_code":"01","label":"Other","value":"L7566","state":"OR","issuer":"LCSW LICENSE"},{"type_code":"01","label":"Other","value":"1104401439","state":"OR","issuer":"NPPES  BUSINESS NPI"},{"type_code":"01","label":"Other","value":"1265833388","state":"OR","issuer":"NPI"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20220413000422","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"OR","pac_id":"9234525551"}]},"enumeration_date":"2021-03-17","last_updated":"2021-08-23","_meta":{"source":"NPPES","snapshot_date":"2021-08-23","doc_url":"https://findmynpi.com/api"}}