Provider Demographics
NPI:1073209102
Name:OPTIMIZE WELLNESS COUNSELING LLC
Entity Type:Organization
Organization Name:OPTIMIZE WELLNESS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-590-2498
Mailing Address - Street 1:632 ANDERSON AVE OFC L
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-1632
Mailing Address - Country:US
Mailing Address - Phone:541-590-2498
Mailing Address - Fax:
Practice Address - Street 1:632 ANDERSON AVE OFC L
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1632
Practice Address - Country:US
Practice Address - Phone:541-297-5449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty