Healthcare Provider Details

I. General information

NPI: 1073454161
Provider Name (Legal Business Name): INSIDE OUT COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5756 YVONNE CT SE
SALEM OR
97306-1257
US

IV. Provider business mailing address

5756 YVONNE CT SE
SALEM OR
97306-1257
US

V. Phone/Fax

Practice location:
  • Phone: 503-480-5085
  • Fax:
Mailing address:
  • Phone: 503-480-5085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: PETR DANCHEV
Title or Position: OWNER
Credential: LPC
Phone: 503-480-5085