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General NPI Number Information
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NPI Number | 1346984952
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Entity Type | Organization
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Legal Business Name | GENUINE CONNECTIONS THERAPY LLC
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 175 W B ST STE B1
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City | SPRINGFIELD
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State | OR
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Zip | 97477-4515
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Country | US
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Telephone | 541-933-9142
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Fax |
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Provider Business Mailing Address
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Address Line | 461 ADAMS ST
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City | EUGENE
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State | OR
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Zip | 97402-4937
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Country | US
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Telephone | 541-933-9142
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA SARABALE
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Credential | LPC
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Telephone | 541-933-9142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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