Organization
AUTUMN LEAF THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARILYN CLAIRE ELLIS PSYD, MSCP (PSYCHOLOGIST/OWNER)
(503) 856-6430
Entity
Organization
Contact information
Practice address
3857 WOLVERINE ST NE STE 6, SALEM, OR 97305-4274
(503) 856-6430
(503) 877-1920
Mailing address
3857 WOLVERINE ST NE STE 6, SALEM, OR 97305-4274
(503) 856-6430
(503) 877-1920
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/03/2020
Last updated
03/05/2020
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