SOUTHERN OREGON CBT LLC
NPI 1306456058
Psychologist - Clinical in Jacksonville, OR

Q: What is Southern Oregon Cbt LLC's NPI number?

The NPI number for Southern Oregon Cbt LLC is 1306456058. It was assigned to this organization in the NPPES registry on August 7, 2020.

Q: What is Southern Oregon Cbt LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Active since August 07, 2020

235 W MAIN ST, JACKSONVILLE, OR 97530(541) 204-4933(800) 433-1396 Get Directions Write a Review

NPPES record last updated: October 29, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 1, 2020, Aug 18, 2020, Aug 7, 2020 (3 updates tracked since 2020).

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About Southern Oregon Cbt Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN OREGON CBT LLC (NPI 1306456058) is a healthcare organization registered as a clinical in Jacksonville, Oregon and active in the NPI registry since August 2020. The organization lists Kacy Mullen, Owner, as its authorized official.

NPPES Registry Identity

NPI1306456058

Entity TypeOrganization

Primary Taxonomy103TC0700X

Legal Business NameSOUTHERN OREGON CBT LLC

Location Address235 W MAIN STJacksonville, OR 97530-9278

Mailing AddressPo Box 4752Medford, OR 97501-0197 · (541) 500-8655

Phone(541) 204-4933

Fax(800) 433-1396

Organization SubpartNo

Authorized OfficialKacy MullenOwner · (541) 500-8655

Enumeration DateAugust 7, 2020

Last NPPES UpdateOctober 29, 20243 updates tracked since enumeration

NPPES CertifiedOctober 29, 2024

✔ NPI 1306456058 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

235 W MAIN ST, Jacksonville, OR 97530

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Moda Health Plan, Inc., Regence BlueCross BlueShield of Oregon.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southern Oregon Cbt Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Southern Oregon Cbt LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Kacy Mullen, PH.D.

Clinical Psychologist

NPI 1801224795

8495 CRATER LAKE HWY
White City, OR 97503

(541) 826-2111

✔ PECOS✔ Accepts Medicare11 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Oregon Cbt LLC's NPI number?

The NPI number for Southern Oregon Cbt LLC is 1306456058. It was assigned to this organization in the NPPES registry on August 7, 2020.

Where is Southern Oregon Cbt LLC located?

Southern Oregon Cbt LLC is located at 235 W Main St, Jacksonville, OR 97530. The listed phone number is (541) 204-4933.

What is Southern Oregon Cbt LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Southern Oregon Cbt LLC enrolled in Medicare?

Yes. Southern Oregon Cbt LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southern Oregon Cbt LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Southern Oregon Cbt LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Southern Oregon Cbt LLC accept?

Health plans from BridgeSpan Health Company, Moda Health Plan, Inc. and Regence BlueCross BlueShield of Oregon list Southern Oregon Cbt LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southern Oregon Cbt LLC was last updated on October 29, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.