Healthcare Provider Details

I. General information

NPI: 1023833779
Provider Name (Legal Business Name): ACHER TRAUMA THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 CAPITOL ST NE
SALEM OR
97301-7881
US

IV. Provider business mailing address

1590 CAPITOL ST NE
SALEM OR
97301-7881
US

V. Phone/Fax

Practice location:
  • Phone: 214-477-0061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH ARCHER
Title or Position: OWNER
Credential: LPC
Phone: 214-477-0061