| Emberleaf Collective, LLC | |
|
629 Kings Ct Central Point OR 97502-2122 | |
| (541) 209-6619 | |
| Not Available |
| Full Name | Emberleaf Collective, LLC |
|---|---|
| Speciality | Counselor |
| Location | 629 Kings Ct, Central Point, Oregon |
| Authorized Official Name and Position | Celeste Lonsbery (SOLE MEMBER) |
| Authorized Official Contact | 5412992350 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Emberleaf Collective, LLC Po Box 5109 Central Point OR 97502-0045 Ph: (541) 209-6619 | Emberleaf Collective, LLC 629 Kings Ct Central Point OR 97502-2122 Ph: (541) 209-6619 |
| NPI Number | 1306737416 |
|---|---|
| Provider Enumeration Date | 07/15/2025 |
| Last Update Date | 07/15/2025 |
| Certification Date | 07/15/2025 |
| Medicare PECOS PAC ID | 3274011242 |
|---|---|
| Medicare Enrollment ID | O20260130002797 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306737416 | NPI | - | NPPES |
| 500797971 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | () | Primary |
| Provider Name | Celeste Lonsbery |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053081448 PECOS PAC ID: 4183102155 Enrollment ID: I20260130002878 |
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