Phoenix Ries, MS,LPC

Individual provider Active NPI Professional Counselor · Philomath, OR

NPI 1437201357 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1437201357
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
License
C1015 (OR)
Practice address
1322 Main St.
Philomath, OR 97370
Phone
(541) 929-5065
NPI assigned
Jan 18, 2007
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
C1015ORMDProfessional Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X C1015 OR Yes

Addresses

Primary practice location

1322 Main St.
Philomath, OR 97370

Mailing address

PO Box 1394
Philomath, OR 97370-1394
Phone (541) 929-5065

Other providers in Philomath, OR

All providers in Philomath, OR · Professional Counselor in Oregon

Sources for this page

Verify at the official NPI Registry.