Healthcare Provider Details

I. General information

NPI: 1255495719
Provider Name (Legal Business Name): ALLIANCE COUNSELING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22018 S CENTRAL POINT RD SUITE #3
CANBY OR
97013-8705
US

IV. Provider business mailing address

22018 S CENTRAL POINT RD SUITE #3
CANBY OR
97013-8705
US

V. Phone/Fax

Practice location:
  • Phone: 503-412-8149
  • Fax: 503-263-6278
Mailing address:
  • Phone: 503-412-8149
  • Fax: 503-263-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC0741
License Number StateOR

VIII. Authorized Official

Name: MS. JOYCE KORSCHGEN
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 503-221-4531