Healthcare Provider Details

I. General information

NPI: 1861576340
Provider Name (Legal Business Name): ICARUS COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 HIGH ST SE STE 204
SALEM OR
97301-3610
US

IV. Provider business mailing address

161 HIGH ST SE STE 204
SALEM OR
97301-3610
US

V. Phone/Fax

Practice location:
  • Phone: 503-581-7550
  • Fax: 503-581-7550
Mailing address:
  • Phone: 503-581-7550
  • Fax: 503-581-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberL0280
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberL0280
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberL0280
License Number StateOR

VIII. Authorized Official

Name: MR. ANTHONY GAGLIARDO
Title or Position: OWNER THERAPIST
Credential: LCSW
Phone: 503-581-7550