Provider Demographics
NPI:1871131201
Name:SILVER FALLS TRAUMA RECOVERY LLC
Entity type:Organization
Organization Name:SILVER FALLS TRAUMA RECOVERY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-860-0987
Mailing Address - Street 1:495 STATE ST STE 540
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3297
Mailing Address - Country:US
Mailing Address - Phone:503-897-9609
Mailing Address - Fax:
Practice Address - Street 1:495 STATE ST STE 540
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3297
Practice Address - Country:US
Practice Address - Phone:503-897-9609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500699205Medicaid