Healthcare Provider Details

I. General information

NPI: 1578481255
Provider Name (Legal Business Name): OSTRACA COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3995 HAGERS GROVE RD SE STE 121
SALEM OR
97317-6189
US

IV. Provider business mailing address

3995 HAGERS GROVE RD SE STE 121
SALEM OR
97317-6189
US

V. Phone/Fax

Practice location:
  • Phone: 503-881-9269
  • Fax:
Mailing address:
  • Phone: 503-881-9269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LUCAS PITMAN
Title or Position: SOLE MEMBER
Credential:
Phone: 503-881-9269