Organization
LIBERTY ADVOCACY GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RENEE BALCOM (FOUNDING DIRECTOR)
(541) 469-7611
Entity
Organization
Contact information
Practice address
1043 CHETCO AVE, BROOKINGS, OR 97415-7152
(541) 469-7611
(866) 835-8295
Mailing address
PO BOX 4404, BROOKINGS, OR 97415-0068
(541) 469-7611
(541) 661-2369
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
163W00000X
Registered Nurse
Primary
094003275RN
OR
Other
Enumeration date
12/07/2012
Last updated
12/07/2012
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