| Light Of Hope, Llc | |
|
960 Broadway St Ne Ste 3 Salem OR 97301-1275 | |
| (503) 489-4747 | |
| (503) 489-9557 |
| Full Name | Light Of Hope, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 960 Broadway St Ne Ste 3, Salem, Oregon |
| Authorized Official Name and Position | Leah Mangis (OWNER/LICENSED CLINICAL SOCIAL WORK) |
| Authorized Official Contact | 5034894747 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Light Of Hope, Llc 960 Broadway St Ne Ste 3 Salem OR 97301-1275 Ph: (503) 489-4747 | Light Of Hope, Llc 960 Broadway St Ne Ste 3 Salem OR 97301-1275 Ph: (503) 489-4747 |
| NPI Number | 1780210294 |
|---|---|
| Provider Enumeration Date | 03/16/2020 |
| Last Update Date | 03/16/2020 |
| Certification Date | 03/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780210294 | NPI | - | NPPES |
| 500708513 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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