MARY KATHERINE BROOK (NPI# 1518404078) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518404078 |
| Entity Type | Individual |
| Full Name | MARY KATHERINE BROOK |
| Practice Address |
1251 Ne Elm St Prineville OR 97754-1206 |
| Mailing Address |
365 Ne Court St Prineville OR 97754-1936 |
| Practice Telephone | 5413235330 |
| Mailing Telephone | 5413235330 |
| Enumeration Date | 2017-01-23 |
| Last Update Date | 2017-01-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | OR | Other Service Providers | |
| N | 175T00000X | Peer Specialist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 283234 | 05 |
| Street Address |
1251 NE ELM ST |
| City | PRINEVILLE |
| State | OR |
| Zip Code | 97754-1206 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982605911 | Kenneth D Long | Physician Assistant | 1251 Ne Elm St, Prineville, OR 97754 | 2005-08-01 |
| 1790222487 | Tara Lee Fetterly | Peer Specialist | 1251 Ne Elm St, Prineville, OR 97754-1206 | 2017-01-19 |
| 1699224899 | Casey Marker | Behavioral Analyst | 1251 Ne Elm St, Prineville, OR 97754-1206 | 2016-09-28 |
| 1285183533 | Katie Morrison | Counselor | 1251 Ne Elm St, Prineville, OR 97754-1206 | 2016-09-28 |
| 1760838668 | Proactive Physical Therapy - Prineville, LLC | Physical Therapist | 1251 Ne Elm St, Prineville, OR 97754-1206 | 2016-05-10 |
| 1497115018 | Glenda Miller | Peer Specialist | 1251 Ne Elm St, Prineville, OR 97754 | 2016-02-24 |
| 1326406901 | Patricia Bates | Case Manager/Care Coordinator | 1251 Ne Elm St, Prineville, OR 97754-1206 | 2016-02-10 |
| 1851756233 | Dawn Mountz | Counselor | 1251 Ne Elm St, Prineville, OR 97754-1206 | 2015-12-29 |
| 1972974665 | Anne Stout | Counselor | 1251 Ne Elm St, Prineville, OR 97754-1206 | 2015-10-07 |
| 1295104057 | Karianne Clark | Social Worker | 1251 Ne Elm St, Prineville, OR 97754-1206 | 2015-09-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598246290 | Phyllis Louise Young | Physical Therapy Assistant | 350 Ne Brennan Ln, Prineville, OR 97754 | 2018-08-22 |
| 1316424518 | Monte Bainbridge | Counselor | 1103 Ne Elm St Ste B, Prineville, OR 97754 | 2018-07-20 |
| 1841739760 | Gregory Wayne Sanders | Marriage & Family Therapist | 445 Nw 3rd Street, Prineville, OR 97754 | 2017-02-13 |
| 1114474962 | Amy R Duryea | Counselor | 1103 Ne Elm St., Prineville, OR 97754 | 2016-09-08 |
| 1669855052 | Rebecca L Griffith | Mechanotherapist | 298 N Holly St, Prineville, OR 97754 | 2015-07-02 |
| 1376810838 | Jessica Lynn Neely | Counselor | 1333 Nw 9th Street, Prineville, OR 97754 | 2011-11-28 |
| 1205076130 | Dean Arthur Laney | Registered Nurse | 375 Nw Beaver St., Suite 100, Prineville, OR 97754 | 2009-03-05 |
| 1699910513 | Ross E Weakley | Acupuncturist | 298 Sw Harwood, Prineville, OR 97754 | 2008-12-05 |
| 1326208752 | Laura Danielle Gratton | Family Medicine | 975 Nw Beaver Street, Prineville, OR 97754 | 2008-06-10 |
| 1811174550 | Central Oregon Eyecare, PC | Optometrist | 198 Ne Combs Flat Rd, Ste 120, Prineville, OR 97754 | 2008-01-24 |
| Find all providers in zip 97754 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982237236 | Jessica M Montoya | Peer Specialist | 235 Se Knowledge St, Prineville, OR 97754-2362 | 2020-02-14 |
| 1508491994 | Daryl Allen Lee | Peer Specialist | 357 Ne Court St, Prineville, OR 97754-1936 | 2020-03-06 |
| 1295384170 | Kayle Ryn Shrauger | Peer Specialist | 357 Ne Court St, Prineville, OR 97754-1936 | 2019-09-04 |
| 1477118842 | Cynthia R Bese | Peer Specialist | 1103 Ne Elm St, Prineville, OR 97754-1664 | 2019-05-01 |
| 1316424971 | Bonnie Mcmillan | Peer Specialist | 1103 Ne Elm St Ste B, Prineville, OR 97754-1664 | 2018-07-25 |
| 1386121044 | Joleigh Creason | Peer Specialist | 1103 Ne Elm St Ste B, Prineville, OR 97754-1664 | 2018-07-25 |
| 1790222487 | Tara Lee Fetterly | Peer Specialist | 1251 Ne Elm St, Prineville, OR 97754-1206 | 2017-01-19 |
| 1366892390 | Shelley Renee Hood | Peer Specialist | 365 Ne Court St, Prineville, OR 97754-1936 | 2016-06-21 |
| 1497115018 | Glenda Miller | Peer Specialist | 1251 Ne Elm St, Prineville, OR 97754 | 2016-02-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487255576 | Thomas Roy Hooks | Peer Specialist | 1221 Sw 11th Ave Apt 102, Portland, OR 97205-2143 | 2020-11-04 |
| 1578162145 | Kenneth Branson | Peer Specialist | 389 Sw Scalehouse Ct Ste 130, Bend, OR 97702-3241 | 2020-10-23 |
| 1962000554 | Dawn Marks | Peer Specialist | 21440 Se Stark St, Gresham, OR 97030-2024 | 2020-10-15 |
| 1679188080 | Michelle Marie Bunkers | Peer Specialist | 20517 Jacklight Ln, Bend, OR 97702-2971 | 2020-09-11 |
| 1538773155 | Mamie Nzigire Zagabe | Peer Specialist | 605 Se Cesar Estrada Chavez Blvd, Portland, OR 97214 | 2020-09-01 |
| 1528677820 | Charice Monette | Peer Specialist | 4151 Kacey Cir Ne, Salem, OR 97305-4504 | 2020-07-23 |
| 1841810322 | Ariana Lee May | Peer Specialist | 1601 Olive St Apt 1008, Eugene, OR 97401-3985 | 2020-04-24 |
| 1134752579 | Lisa Kennedy | Peer Specialist | 132 Ne B St # 24, Grants Pass, OR 97526-2114 | 2020-02-13 |
| 1730711953 | Michael Anthony Duran | Peer Specialist | 1515 Hill St Se, Albany, OR 97322-6715 | 2020-02-05 |
| 1205476777 | Kyla M Mccormick | Peer Specialist | 109 Nw Manzanita Avenue, Grants Pass, OR 97526 | 2020-01-13 |
| Find all providers with the same taxonomy | ||||
| City | PRINEVILLE |
| Zip Code | 97754 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.