| Shade Tree Counseling | |
|
4210 Barrett St S Salem OR 97302-6106 | |
| (503) 949-1026 | |
| Not Available |
| Full Name | Shade Tree Counseling |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4210 Barrett St S, Salem, Oregon |
| Authorized Official Name and Position | Robert Wayne Nielsen (PARTNER) |
| Authorized Official Contact | 5039491026 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shade Tree Counseling 4210 Barrett St S Salem OR 97302-6106 Ph: (503) 949-1026 | Shade Tree Counseling 4210 Barrett St S Salem OR 97302-6106 Ph: (503) 949-1026 |
| NPI Number | 1023688439 |
|---|---|
| Provider Enumeration Date | 06/28/2021 |
| Last Update Date | 06/28/2021 |
| Certification Date | 06/28/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023688439 | NPI | - | NPPES |
| 1861556425 | Medicaid | OR | |
| 1508083601 | Medicaid | OR | |
| 1902279334 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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