Healthcare Provider Details

I. General information

NPI: 1316755242
Provider Name (Legal Business Name): UNKNOWN RIDGHAUS ASSOCIATE LICENSED P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANDREW TASH

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 09/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LIBERTY ST SE
SALEM OR
97302
US

IV. Provider business mailing address

1515 LIBERTY ST SE
SALEM OR
97302
US

V. Phone/Fax

Practice location:
  • Phone: 503-951-6280
  • Fax: 503-468-3130
Mailing address:
  • Phone: 503-951-6280
  • Fax: 503-468-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR12496
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: