Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | OR |
NPI | 1003484718 |
---|---|
Provider Name | Lynda Raylene Conley |
First Address | Salem, OR 97301-7305 |
Second Address | Salem, OR 97301-4255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2021 |
Last Update Date | 17/06/2021 |