NPI 1689209371 · live from the CMS NPI Registry
Autumn Leaf Therapeutic Services
Community/Behavioral Health in Salem, OR. National Provider Identifier 1689209371, active.
NPI record
| NPI | 1689209371 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Community/Behavioral Health 251S00000X |
| Practice location | 3857 Wolverine St Ne Ste 6, Salem, OR 97305 |
| Practice phone | 503-856-6430 |
| Enumerated | March 3, 2020 |
| Last updated | March 5, 2020 |
| Authorized official | Carilyn Ellis, Psychologist/Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist | 103T00000X | — |
| Community/Behavioral Health primary | 251S00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.