| Ethos Therapy Services Llc | |
|
2667 Sw Salmon Ave Redmond OR 97756-9466 | |
| (541) 313-8660 | |
| Not Available |
| Full Name | Ethos Therapy Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 2667 Sw Salmon Ave, Redmond, Oregon |
| Authorized Official Name and Position | Elise Devanport (OWNER) |
| Authorized Official Contact | 5413138660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ethos Therapy Services Llc 2667 Sw Salmon Ave Redmond OR 97756-9466 Ph: () - | Ethos Therapy Services Llc 2667 Sw Salmon Ave Redmond OR 97756-9466 Ph: (541) 313-8660 |
| NPI Number | 1609629492 |
|---|---|
| Provider Enumeration Date | 04/10/2024 |
| Last Update Date | 04/10/2024 |
| Certification Date | 04/10/2024 |
| Medicare PECOS PAC ID | 6305387127 |
|---|---|
| Medicare Enrollment ID | O20240920001520 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609629492 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| Provider Name | Elise Louise Davenport |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467870048 PECOS PAC ID: 8325262132 Enrollment ID: I20160825001270 |
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