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Organization
TABULA RASA WELLNESS LLC
Active
Organization
TABULA RASA WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDSAY CROWNER LCSW (OWNER/CLINICAL SOCIAL WORKER)
(509) 430-7578
Entity
Organization
Contact information
Practice address
2105 LIBERTY ST NE, SALEM, OR 97301-8353
(503) 967-3428
(503) 967-3683
Mailing address
3434 LIBERTY RD S APT 65, SALEM, OR 97302-6628
(509) 430-7578
(503) 967-3683
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
01/16/2019
Last updated
01/31/2021
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