Healthcare Provider Details

I. General information

NPI: 1861000614
Provider Name (Legal Business Name): QUALITY OF LIFE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 ROBBINS ST
MOLALLA OR
97038-8141
US

IV. Provider business mailing address

PO BOX 85
MOLALLA OR
97038-0085
US

V. Phone/Fax

Practice location:
  • Phone: 971-999-0175
  • Fax:
Mailing address:
  • Phone: 971-339-9339
  • Fax: 855-651-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY PETERS
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 971-999-0175