Autumn Leaf Therapeutic Services
Community/Behavioral Health in Salem, Oregon
1689209371- Practice location
- 3857 Wolverine St NE Ste 6, Salem, OR 97305-4274
- Phone
- 503-856-6430
- Fax
- 503-877-1920
- Last updated
- March 5, 2020
Autumn Leaf Therapeutic Services is a healthcare organization based in Salem, OR. The NPI number for Autumn Leaf Therapeutic Services is 1689209371. The current practice location address is 3857 Wolverine St NE Ste 6, Salem, OR 97305-4274 and the office can be reached by phone at 503-856-6430 and by fax at 503-877-1920. The NPI was assigned on March 3, 2020 and the record was last updated in NPPES on March 5, 2020.
●Provider Profile Details
- NPI Number
- 1689209371
- Provider Name
- Autumn Leaf Therapeutic Services
- Entity Type
- Organization (Type 2 NPI)
- Primary Taxonomy
- Community/Behavioral Health · 251S00000X
- Organization Subpart
- No
- Authorized Official
- Carilyn Claire Ellis, PSYD, MSCP · Psychologist/Owner · 503-856-6430
- Enumeration Date
- March 3, 2020
- Last Update Date
- March 5, 2020
- Certification Date
- March 5, 2020
- NPI Status
- Active
◉Business Practice Location Address
- Address
- 3857 Wolverine St NE Ste 6
Salem, OR 97305-4274 - City
- Salem
- State
- Oregon
- ZIP
- 97305-4274
- Country
- US
- Phone Number
- 503-856-6430
- Fax Number
- 503-877-1920
✉Business Mailing Address
- Address
- 3857 Wolverine St NE Ste 6
Salem, OR 97305-4274 - City
- Salem
- State
- OR
- ZIP
- 97305-4274
- Phone Number
- 503-856-6430
- Fax Number
- 503-877-1920
✎Taxonomy & License Information
| Taxonomy | Code | Primary | License | State |
|---|---|---|---|---|
| Psychologist 193400000X - Single Specialty Group | 103T00000X | No | — | — |
| Community/Behavioral Health | 251S00000X | Yes | — | — |
#Other Provider Identifiers
No legacy or other identifiers (Medicaid, Medicare or plan IDs) are on file for this provider.
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View all providers in Salem →?Frequently Asked Questions
What is the NPI number of Autumn Leaf Therapeutic Services?
The NPI number of Autumn Leaf Therapeutic Services is 1689209371. It was assigned on March 3, 2020 and is currently active in the NPPES registry.
What is the specialty of Autumn Leaf Therapeutic Services?
Autumn Leaf Therapeutic Services is registered under the primary taxonomy Community/Behavioral Health (code 251S00000X).
Where does Autumn Leaf Therapeutic Services practice?
The practice location is 3857 Wolverine St NE Ste 6, Salem, OR 97305-4274. The office can be reached at 503-856-6430 (phone) or 503-877-1920 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1689209371 directly on the NPPES registry website at npiregistry.cms.hhs.gov.