Provider Demographics
NPI:1659866911
Name:CHAKRA LLC
Entity Type:Organization
Organization Name:CHAKRA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MUNI
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CADC, LPC INTERN
Authorized Official - Phone:503-501-6991
Mailing Address - Street 1:161 HIGH ST SE STE 209
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3693
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:161 HIGH ST SE STE 209
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3693
Practice Address - Country:US
Practice Address - Phone:971-283-9924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty