| Kitchen Table Counseling | |
|
180 Clear Creek Dr Ste 104 Ashland OR 97520-1993 | |
| (541) 816-5462 | |
| Not Available |
| Full Name | Kitchen Table Counseling |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 180 Clear Creek Dr Ste 104, Ashland, Oregon |
| Authorized Official Name and Position | Rochelle Deforrest (OWNER) |
| Authorized Official Contact | 5418165462 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kitchen Table Counseling Po Box 1787 Medford OR 97501-0261 Ph: (541) 500-8655 | Kitchen Table Counseling 180 Clear Creek Dr Ste 104 Ashland OR 97520-1993 Ph: (541) 816-5462 |
| NPI Number | 1215528476 |
|---|---|
| Provider Enumeration Date | 01/31/2021 |
| Last Update Date | 01/14/2024 |
| Certification Date | 01/14/2024 |
| Medicare PECOS PAC ID | 7214370717 |
|---|---|
| Medicare Enrollment ID | O20240212004238 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215528476 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Rochelle De Forrest |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1578071759 PECOS PAC ID: 4880037381 Enrollment ID: I20240212004182 |
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