Provider Demographics
NPI:1063525087
Name:VALLEY PROFESSIONAL COUNSELING INC
Entity type:Organization
Organization Name:VALLEY PROFESSIONAL COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CSWA, CADC
Authorized Official - Phone:503-370-9200
Mailing Address - Street 1:750 HAWTHORNE AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4675
Mailing Address - Country:US
Mailing Address - Phone:503-370-9200
Mailing Address - Fax:503-370-9210
Practice Address - Street 1:750 HAWTHORNE AVE NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4675
Practice Address - Country:US
Practice Address - Phone:503-370-9200
Practice Address - Fax:503-370-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR279101YA0400X
OR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR279OtherALCOHOL/OUTPATIENT
OR028317Medicaid