Healthcare Provider Details

I. General information

NPI: 1346171592
Provider Name (Legal Business Name): GOLD PATH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N FRONT ST STE 225
COOS BAY OR
97420-4909
US

IV. Provider business mailing address

PO BOX 1048
COOS BAY OR
97420-0227
US

V. Phone/Fax

Practice location:
  • Phone: 541-297-6516
  • Fax:
Mailing address:
  • Phone: 541-294-9770
  • Fax: 877-514-3809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MELISSA RENEE PALLIN
Title or Position: OWNER/LCSW CLINICIAN
Credential: LCSW
Phone: 541-294-9770