Provider Demographics
NPI:1972382281
Name:FIDELITY FAMILY THERAPY AND CONSULTING
Entity type:Organization
Organization Name:FIDELITY FAMILY THERAPY AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:503-871-2330
Mailing Address - Street 1:1155 MARKET ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1135
Mailing Address - Country:US
Mailing Address - Phone:503-871-2330
Mailing Address - Fax:
Practice Address - Street 1:355 HIGH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3613
Practice Address - Country:US
Practice Address - Phone:971-600-1603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty