Provider Demographics
NPI:1033382916
Name:PACIFIC CREST COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:PACIFIC CREST COUNSELING CENTER LLC
Other - Org Name:INNERWORK COUNSELING CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:W
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:503-223-7719
Mailing Address - Street 1:8035 NE PRESCOTT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-4249
Mailing Address - Country:US
Mailing Address - Phone:503-223-7719
Mailing Address - Fax:503-255-4714
Practice Address - Street 1:8035 NE PRESCOTT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-4249
Practice Address - Country:US
Practice Address - Phone:503-223-7719
Practice Address - Fax:503-255-4714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty