Organization
BRANCHES OF CHANGE COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LACEY MARIE FAUGHENDER LCSW (LCSW/ OWNER)
(503) 902-5930
Entity
Organization
Contact information
Practice address
161 HIGH ST SE STE 202, SALEM, OR 97301-3610
(509) 902-5930
(503) 917-5991
Mailing address
161 HIGH ST SE STE 202, SALEM, OR 97301-3610
(509) 902-5930
(503) 917-5991
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500685336
—
OR
Enumeration date
08/24/2022
Last updated
08/24/2022
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