| Liberty Advocacy Group Inc. | |
|
1043 Chetco Ave Brookings OR 97415-7152 | |
| (541) 469-7611 | |
| (866) 835-8295 |
| Full Name | Liberty Advocacy Group Inc. |
|---|---|
| Speciality | Registered Nurse |
| Location | 1043 Chetco Ave, Brookings, Oregon |
| Authorized Official Name and Position | Renee Balcom (FOUNDING DIRECTOR) |
| Authorized Official Contact | 5414697611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Liberty Advocacy Group Inc. Po Box 4404 Brookings OR 97415-0068 Ph: (541) 469-7611 | Liberty Advocacy Group Inc. 1043 Chetco Ave Brookings OR 97415-7152 Ph: (541) 469-7611 |
| NPI Number | 1235474842 |
|---|---|
| Provider Enumeration Date | 12/07/2012 |
| Last Update Date | 12/07/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235474842 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 163W00000X | Registered Nurse | 094003275RN (Oregon) | Primary |
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