Autumn Leaf Therapeutic Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

AUTUMN LEAF THERAPEUTIC SERVICES

Practice address

3857 Wolverine St NE Ste 6
Salem, OR 97305-4274

Phone

(503) 856-6430

Fax

(503) 877-1920

NPI assigned

Mar 3, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carilyn Claire Ellis, PSYD, MSCPNPI 1962888388

Title

Psychologist/Owner

Phone

(503) 856-6430

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carilyn Claire Ellis, PSYD, MSCP

  • Psychologist
  • Salem, OR
  • NPI 1962888388
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583366400000",
    "number": "1689209371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3857 WOLVERINE ST NE STE 6",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973054274",
            "telephone_number": "503-856-6430",
            "fax_number": "503-877-1920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3857 WOLVERINE ST NE STE 6",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973054274",
            "telephone_number": "503-856-6430",
            "fax_number": "503-877-1920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN LEAF THERAPEUTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-03",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "CARILYN",
        "authorized_official_middle_name": "CLAIRE",
        "authorized_official_title_or_position": "PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "503-856-6430",
        "authorized_official_credential": "PSYD, MSCP"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corry Austin
• Edwin Neal Austin, MD
• James Austin, BS, CADC-I
• Patrick Justin Austin
• Scott L Austin
• Avamere Home Health Care, LLC
• Kara Avant, CADC-R
• Laura Lee Avery-Valentine, M.S.,C.T.R.S.
• Sara Jane Avery, BA
• Erika N Avgi

• Community/Behavioral Health Agency in Salem, OR
• Providers in Salem, OR by specialty
• Community/Behavioral Health Agency in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.