Healthcare Provider Details

I. General information

NPI: 1487144986
Provider Name (Legal Business Name): EFFECTIVE FOUNDATIONS COUNSELING AND CONSULTATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 COURT ST NE STE 205
SALEM OR
97301-3443
US

IV. Provider business mailing address

280 COURT ST NE STE 205
SALEM OR
97301-3443
US

V. Phone/Fax

Practice location:
  • Phone: 971-217-7754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: OLGA LEONOVA
Title or Position: PROGRAM DIRECTOR
Credential: LPC
Phone: 971-217-7754