Individual
CONNOR LEE ULLRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 SERENITY LN, COBURG, OR 97408-9350
(541) 692-8200
Mailing address
1 SERENITY LN, COBURG, OR 97408-9350
(541) 692-8200
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-25-6166
OR
Other
Enumeration date
11/21/2025
Last updated
11/21/2025
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