| Radical Nest Llc | |
|
880 Liberty St Ne Ste 109 Salem OR 97301-2450 | |
| (971) 345-4119 | |
| (971) 345-4149 |
| Full Name | Radical Nest Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 880 Liberty St Ne Ste 109, Salem, Oregon |
| Authorized Official Name and Position | Michelle Harvey (OWNER/THERAPIST) |
| Authorized Official Contact | 9713454119 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Radical Nest Llc 880 Liberty St Ne Ste 109 Salem OR 97301-2450 Ph: (971) 345-4119 | Radical Nest Llc 880 Liberty St Ne Ste 109 Salem OR 97301-2450 Ph: (971) 345-4119 |
| NPI Number | 1649874488 |
|---|---|
| Provider Enumeration Date | 11/23/2020 |
| Last Update Date | 07/24/2024 |
| Certification Date | 07/24/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649874488 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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