Kitchen Table Counseling | |
180 Clear Creek Dr Ste 104 Ashland OR 97520-1993 | |
(541) 816-5462 | |
Not Available |
Full Name | Kitchen Table Counseling |
---|---|
Speciality | Community/Behavioral Health |
Location | 180 Clear Creek Dr Ste 104, Ashland, Oregon |
Authorized Official Name and Position | Rochelle Deforrest (OWNER) |
Authorized Official Contact | 5418165462 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Kitchen Table Counseling Po Box 1787 Medford OR 97501-0261 Ph: (541) 500-8655 | Kitchen Table Counseling 180 Clear Creek Dr Ste 104 Ashland OR 97520-1993 Ph: (541) 816-5462 |
NPI Number | 1215528476 |
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Provider Enumeration Date | 01/31/2021 |
Last Update Date | 01/14/2024 |
Certification Date | 01/14/2024 |
Medicare PECOS PAC ID | 7214370717 |
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Medicare Enrollment ID | O20240212004238 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215528476 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Provider Name | Rochelle De Forrest |
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Provider Type | Practitioner - Marriage And Family Therapist |
Provider Identifiers | NPI Number: 1578071759 PECOS PAC ID: 4880037381 Enrollment ID: I20240212004182 |
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