Provider Demographics
NPI:1033678461
Name:NOVA COUNSELING AND CONSULTING LLC
Entity Type:Organization
Organization Name:NOVA COUNSELING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUILLION
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:971-291-0626
Mailing Address - Street 1:5304 SE 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5737
Mailing Address - Country:US
Mailing Address - Phone:971-291-0626
Mailing Address - Fax:
Practice Address - Street 1:333 NE RUSSELL ST STE 209
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3762
Practice Address - Country:US
Practice Address - Phone:971-291-0626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty