Healthcare Provider Details

I. General information

NPI: 1356073514
Provider Name (Legal Business Name): SUNSHINE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 COMMERCIAL ST NE STE 204
SALEM OR
97301-3435
US

IV. Provider business mailing address

247 COMMERCIAL ST NE STE 204
SALEM OR
97301-3435
US

V. Phone/Fax

Practice location:
  • Phone: 971-304-5285
  • Fax:
Mailing address:
  • Phone: 971-304-5285
  • 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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAITY IMBS
Title or Position: OWNER
Credential:
Phone: 971-304-5285