Healthcare Provider Details

I. General information

NPI: 1023935939
Provider Name (Legal Business Name): HEALING PATH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 W PARK CT NW
SALEM OR
97304-2450
US

IV. Provider business mailing address

2028 W PARK CT NW
SALEM OR
97304-2450
US

V. Phone/Fax

Practice location:
  • Phone: 808-495-3093
  • Fax:
Mailing address:
  • Phone: 808-495-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: XAN K DECAMBRA
Title or Position: OWNER
Credential: LMFT
Phone: 808-495-3093