MEDICARE: FREEDOM PATH COUNSELING LLC

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1417645474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM PATH COUNSELING LLC

Provider Business Mailing Address
First Line	:	3819 ALCONA ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97478-6430
Country	:	US
Telephone Number	:	541-515-7793
Fax Number	:	877-301-0283

Provider Business Practice Location Address
First Line	:	3819 ALCONA ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97478-6430
Country	:	US
Telephone Number	:	541-337-5265
Fax Number	:	877-301-0283

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	RUTH RALPH
Credential	:	MA, LPC
Telephone Number	:	541-515-7793

Provider Enumeration Date	:	04/27/2023
Last Update Date	:	04/16/2026

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