Organization
SHADE TREE COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT WAYNE NIELSEN LCSW (PARTNER)
(503) 949-1026
Entity
Organization
Contact information
Practice address
4210 BARRETT ST S, SALEM, OR 97302-6106
(503) 949-1026
Mailing address
4210 BARRETT ST S, SALEM, OR 97302-6106
(503) 949-1026
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508083601
—
OR
05
—
1861556425
—
OR
05
—
1902279334
—
OR
Enumeration date
06/28/2021
Last updated
06/28/2021
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