Organization
LILAC WELLNESS
Active
Other names
Lilac Wellness and Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
PAM CONNELL (ADMINISTRATION)
(503) 587-9937
Entity
Organization
Contact information
Practice address
2651 COMMERCIAL ST SE STE 1, SALEM, OR 97302-4872
(503) 587-9937
(503) 994-8049
Mailing address
2651 COMMERCIAL ST SE STE 1, SALEM, OR 97302-4872
(503) 587-9937
(503) 994-8049
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500688899
—
OR
Enumeration date
04/02/2018
Last updated
12/13/2019
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