| Community Roots Counseling, Llc | |
|
494 State St Ste 270 Salem OR 97301-3647 | |
| (503) 583-2121 | |
| (855) 855-4872 |
| Full Name | Community Roots Counseling, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 494 State St Ste 270, Salem, Oregon |
| Authorized Official Name and Position | Jes Dimas (THERAPIST AND FOUNDER) |
| Authorized Official Contact | 5035832121 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Roots Counseling, Llc Po Box 5312 Salem OR 97304-0312 Ph: (503) 583-2121 | Community Roots Counseling, Llc 494 State St Ste 270 Salem OR 97301-3647 Ph: (503) 583-2121 |
| NPI Number | 1417567983 |
|---|---|
| Provider Enumeration Date | 08/08/2020 |
| Last Update Date | 09/12/2023 |
| Certification Date | 09/12/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417567983 | NPI | - | NPPES |
| 500688776 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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