Organization
PURE LIFE COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN FENNIMORE LCSW (MENTAL HEALTH CLINICIAN)
(503) 428-2948
Entity
Organization
Contact information
Practice address
494 STATE ST STE 270, SALEM, OR 97301-3647
(503) 583-2121
Mailing address
2860 WINTER ST SE, SALEM, OR 97302-3155
(503) 428-2948
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417567983
—
OR
05
—
1881094324
—
OR
Enumeration date
08/29/2023
Last updated
08/29/2023
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