Organization
MY LIFE ALIVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN HEIDECKE (COUNSELOR)
(503) 807-3444
Entity
Organization
Contact information
Practice address
388 STATE ST, SUITE 705, SALEM, OR 97301-3866
(503) 807-3444
Mailing address
PO BOX 4461, SALEM, OR 97302-8461
(503) 807-3444
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
C4060
OR
Other
Enumeration date
04/18/2016
Last updated
04/18/2016
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