Branches Of Change Counseling Llc | |
161 High St Se Ste 202 Salem OR 97301-3610 | |
(509) 902-5930 | |
(503) 917-5991 |
Full Name | Branches Of Change Counseling Llc |
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Speciality | Social Worker |
Location | 161 High St Se Ste 202, Salem, Oregon |
Authorized Official Name and Position | Lacey Marie Faughender (LCSW/ OWNER) |
Authorized Official Contact | 5039025930 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Branches Of Change Counseling Llc 161 High St Se Ste 202 Salem OR 97301-3610 Ph: (509) 902-5930 | Branches Of Change Counseling Llc 161 High St Se Ste 202 Salem OR 97301-3610 Ph: (509) 902-5930 |
NPI Number | 1770202517 |
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Provider Enumeration Date | 08/24/2022 |
Last Update Date | 08/24/2022 |
Certification Date | 08/24/2022 |
Medicare PECOS PAC ID | 4183091721 |
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Medicare Enrollment ID | O20221110001262 |
Identifier | Type | State | Issuer |
---|---|---|---|
1770202517 | NPI | - | NPPES |
500685336 | Medicaid | OR |
Provider Name | Lacey Faughender |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1891102562 PECOS PAC ID: 7214202050 Enrollment ID: I20171004003276 |
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