Provider Demographics
NPI:1861000614
Name:QUALITY OF LIFE THERAPY LLC
Entity Type:Organization
Organization Name:QUALITY OF LIFE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:971-338-9338
Mailing Address - Street 1:PO BOX 9274
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-0274
Mailing Address - Country:US
Mailing Address - Phone:971-339-9339
Mailing Address - Fax:855-651-0575
Practice Address - Street 1:1380 HINES ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2528
Practice Address - Country:US
Practice Address - Phone:971-339-9339
Practice Address - Fax:855-651-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty