Healthcare Provider Details

I. General information

NPI: 1366178394
Provider Name (Legal Business Name): PACIFIC NORTHWEST COUNSELING & CONSULTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 COMMERCIAL ST SE STE 201
SALEM OR
97301-3463
US

IV. Provider business mailing address

780 COMMERCIAL ST SE STE 201
SALEM OR
97301-3463
US

V. Phone/Fax

Practice location:
  • Phone: 971-373-4533
  • Fax: 503-296-5997
Mailing address:
  • Phone: 971-373-4533
  • Fax: 503-296-5997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SARAH HANSEN
Title or Position: MENTAL HEALTH THERAPIST
Credential: LPC
Phone: 971-373-4533