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NPI Code Detail

MEDICARE: VISTA COUNSELING ASSOCIATES

MEDICARE: VISTA COUNSELING ASSOCIATES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorL0191OR

General Provider Information

NPI Number : 1164632279
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISTA COUNSELING ASSOCIATES
Provider Business Mailing Address
First Line : 1698 LIBERTY ST SE
Second Line :
City : SALEM
State : OR
Zip : 97302-4348
Country : US
Telephone Number : 503-370-7775
Fax Number : 503-364-7272
Provider Business Practice Location Address
First Line : 1698 LIBERTY ST SE
Second Line :
City : SALEM
State : OR
Zip : 97302-4348
Country : US
Telephone Number : 503-370-7775
Fax Number : 503-364-7272
Authorized Official
Title or Position : DIRECTOR
Name : MR. RICHARD B. BOLTON
Credential : LCSW
Telephone Number : 503-370-7775
Provider Enumeration Date : 05/23/2007
Last Update Date : 08/22/2020

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Directions to “VISTA COUNSELING ASSOCIATES ” Practice Location

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