| Tabula Rasa Wellness Llc | |
|
2105 Liberty St Ne Salem OR 97301-8353 | |
| (503) 967-3428 | |
| (503) 967-3683 |
| Full Name | Tabula Rasa Wellness Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2105 Liberty St Ne, Salem, Oregon |
| Authorized Official Name and Position | Lindsay Crowner (OWNER/CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 5094307578 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tabula Rasa Wellness Llc 3434 Liberty Rd S Apt 65 Salem OR 97302-6628 Ph: (509) 430-7578 | Tabula Rasa Wellness Llc 2105 Liberty St Ne Salem OR 97301-8353 Ph: (503) 967-3428 |
| NPI Number | 1205300837 |
|---|---|
| Provider Enumeration Date | 01/16/2019 |
| Last Update Date | 01/31/2021 |
| Certification Date | 01/31/2021 |
| Medicare PECOS PAC ID | 0941676662 |
|---|---|
| Medicare Enrollment ID | O20221021000547 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205300837 | NPI | - | NPPES |
| Provider Name | Lindsay Nichole Crowner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295181246 PECOS PAC ID: 2567796824 Enrollment ID: I20190620002633 |
| Provider Name | Lori Kloss |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871146316 PECOS PAC ID: 0749635266 Enrollment ID: I20240216000880 |
| Provider Name | Niki L. Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164931614 PECOS PAC ID: 1456891944 Enrollment ID: I20240911001572 |
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