| Philomath Counseling, Llc | |
|
1229 Main St. #105 Philomath OR 97370 | |
| (541) 929-2878 | |
| (541) 929-3770 |
| Full Name | Philomath Counseling, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1229 Main St. #105, Philomath, Oregon |
| Authorized Official Name and Position | Jeanne A Gregg (MEMBER) |
| Authorized Official Contact | 5419292878 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Philomath Counseling, Llc Po Box 1606 Philomath OR 97370-1606 Ph: (541) 929-2878 | Philomath Counseling, Llc 1229 Main St. #105 Philomath OR 97370 Ph: (541) 929-2878 |
| NPI Number | 1255850889 |
|---|---|
| Provider Enumeration Date | 09/14/2017 |
| Last Update Date | 09/14/2017 |
| Medicare PECOS PAC ID | 6507228392 |
|---|---|
| Medicare Enrollment ID | O20230810001773 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255850889 | NPI | - | NPPES |
| 043278 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | L4097 (Oregon) | Primary |
| Provider Name | Jeanne A Gregg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013074194 PECOS PAC ID: 0648579060 Enrollment ID: I20160505001636 |
| Provider Name | Raina J Wickham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457686073 PECOS PAC ID: 2163702846 Enrollment ID: I20161215001493 |
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