| Pure Life Counseling, Llc | |
|
494 State St Ste 270 Salem OR 97301-3647 | |
| (503) 583-2121 | |
| Not Available |
| Full Name | Pure Life Counseling, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 494 State St Ste 270, Salem, Oregon |
| Authorized Official Name and Position | Benjamin Fennimore (MENTAL HEALTH CLINICIAN) |
| Authorized Official Contact | 5034282948 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pure Life Counseling, Llc 2860 Winter St Se Salem OR 97302-3155 Ph: (503) 428-2948 | Pure Life Counseling, Llc 494 State St Ste 270 Salem OR 97301-3647 Ph: (503) 583-2121 |
| NPI Number | 1982489951 |
|---|---|
| Provider Enumeration Date | 08/29/2023 |
| Last Update Date | 08/29/2023 |
| Certification Date | 07/05/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982489951 | NPI | - | NPPES |
| 1417567983 | Medicaid | OR | |
| 1881094324 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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