Healthcare Provider Details

I. General information

NPI: 1194112243
Provider Name (Legal Business Name): EMPOWERING CHOICES COUNSELING & CONSULTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 LIBERTY ST NE SUITE 2
SALEM OR
97301-2451
US

IV. Provider business mailing address

805 LIBERTY ST NE SUITE 2
SALEM OR
97301
US

V. Phone/Fax

Practice location:
  • Phone: 503-589-3112
  • Fax: 503-589-3179
Mailing address:
  • Phone: 503-589-3112
  • Fax: 503-589-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANDA ANITA GRIGSBY
Title or Position: COUNSELOR, PARTNER
Credential: LPC
Phone: 541-740-6589