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Organization

BLUE IRIS RIVER COUNSELING LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TERRY BANTA LCSW (SOCIAL WORKER)
(503) 559-8831
Entity
Organization

Contact information

Practice address
2460 4TH ST NE, SALEM, OR 97301-8332
(503) 559-8831
Mailing address
2460 4TH ST NE, SALEM, OR 97301-8332

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary

Other

Enumeration date
08/15/2022
Last updated
08/16/2022
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