Healthcare Provider Details

I. General information

NPI: 1417645474
Provider Name (Legal Business Name): FREEDOM PATH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3819 ALCONA ST
SPRINGFIELD OR
97478-6430
US

IV. Provider business mailing address

3819 ALCONA ST
SPRINGFIELD OR
97478-6430
US

V. Phone/Fax

Practice location:
  • Phone: 541-337-5265
  • Fax: 877-301-0283
Mailing address:
  • Phone: 541-515-7793
  • Fax: 877-301-0283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RUTH RALPH
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA, LPC
Phone: 541-515-7793