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General NPI Number Information
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NPI Number | 1669725719
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Entity Type | Organization
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Legal Business Name | LIFECRAFT COUNSELING LLC
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 189 LIBERTY ST NE
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City | SALEM
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State | OR
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Zip | 97301-3682
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Country | US
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Telephone | 503-860-9276
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Fax |
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Provider Business Mailing Address
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Address Line | 672 RIVERVIEW DR NW
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City | SALEM
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State | OR
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Zip | 97304-4344
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Country | US
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Telephone | 503-860-9276
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | GAIL ANN BILLS
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Credential | LCSW
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Telephone | 503-860-9276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4336
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License Number State | OR
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