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General NPI Number Information
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NPI Number | 1740894856
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Entity Type | Organization
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Legal Business Name | CONSCIOUS LIFE COUNSELING, LLC
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 107 E MAIN ST STE 7
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City | MEDFORD
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State | OR
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Zip | 97501-6022
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Country | US
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Telephone | 541-414-4337
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Fax |
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Provider Business Mailing Address
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Address Line | 2253 RIDGE WAY
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City | MEDFORD
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State | OR
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Zip | 97504-6388
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Country | US
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Telephone | 541-613-7015
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MAIRE MURPHY
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Credential | LPC
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Telephone | 541-414-4337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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