Pure Life Counseling, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

PURE LIFE COUNSELING, LLC

Practice address

494 State St Ste 270
Salem, OR 97301-3647

Phone

(503) 583-2121

NPI assigned

Aug 29, 2023

Organization subpart

No

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

Authorized official

Name

Benjamin Fennimore, LCSWNPI 1881094324

Title

Mental Health Clinician

Phone

(503) 428-2948

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• Benjamin Fennimore, LCSW

  • Clinical Social Worker
  • Salem, OR
  • NPI 1881094324
  NPD Authorized official

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

{
    "created_epoch": "1693267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693267200000",
    "number": "1982489951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2860 WINTER ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973023155",
            "telephone_number": "503-428-2948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "494 STATE ST STE 270",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013647",
            "telephone_number": "503-583-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE LIFE COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-29",
        "last_updated": "2023-08-29",
        "certification_date": "2023-07-05",
        "status": "A",
        "authorized_official_last_name": "FENNIMORE",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "MENTAL HEALTH CLINICIAN",
        "authorized_official_telephone_number": "503-428-2948",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417567983",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881094324",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Pungercar
• Amber M Purdy, PHARMD
• Frances Purdy
• Pure Dental PC
• Pure Health Medical Clinic
• Pure Massage & Spa LLC
• Pure Massage LLC
• Isaac Pureco
• Purehealth Medical Clinic, Corp
• William Ebbert Purnell Jr., MD

• Clinical Social Worker in Salem, OR
• Providers in Salem, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; 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.