| Icarus Counseling Inc | |
|
161 High St Se Ste 204 Salem OR 97301-3610 | |
| (503) 581-7550 | |
| (503) 581-7550 |
| Full Name | Icarus Counseling Inc |
|---|---|
| Speciality | Counselor |
| Location | 161 High St Se Ste 204, Salem, Oregon |
| Authorized Official Name and Position | Anthony Gagliardo (OWNER THERAPIST) |
| Authorized Official Contact | 5035817550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Icarus Counseling Inc 161 High St Se Ste 204 Salem OR 97301-3610 Ph: (503) 581-7550 | Icarus Counseling Inc 161 High St Se Ste 204 Salem OR 97301-3610 Ph: (503) 581-7550 |
| NPI Number | 1861576340 |
|---|---|
| Provider Enumeration Date | 10/24/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5890681845 |
|---|---|
| Medicare Enrollment ID | O20040225001147 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861576340 | NPI | - | NPPES |
| Provider Name | Anthony Gagliardo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922022946 PECOS PAC ID: 5991609299 Enrollment ID: I20031120000378 |
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