| Autumn Leaf Therapeutic Services | |
|
3857 Wolverine St Ne Ste 6 Salem OR 97305-4274 | |
| (503) 856-6430 | |
| (503) 877-1920 |
| Full Name | Autumn Leaf Therapeutic Services |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3857 Wolverine St Ne Ste 6, Salem, Oregon |
| Authorized Official Name and Position | Carilyn Claire Ellis (PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 5038566430 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Autumn Leaf Therapeutic Services 3857 Wolverine St Ne Ste 6 Salem OR 97305-4274 Ph: (503) 856-6430 | Autumn Leaf Therapeutic Services 3857 Wolverine St Ne Ste 6 Salem OR 97305-4274 Ph: (503) 856-6430 |
| NPI Number | 1689209371 |
|---|---|
| Provider Enumeration Date | 03/03/2020 |
| Last Update Date | 03/05/2020 |
| Certification Date | 03/05/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689209371 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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