Provider Demographics
NPI:1114652633
Name:ENDEAVOR COUNSELING AND CONSULTATION LLC
Entity Type:Organization
Organization Name:ENDEAVOR COUNSELING AND CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-490-4829
Mailing Address - Street 1:401 NE 19TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-4800
Mailing Address - Country:US
Mailing Address - Phone:503-298-4661
Mailing Address - Fax:971-288-0587
Practice Address - Street 1:401 NE 19TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-4800
Practice Address - Country:US
Practice Address - Phone:503-298-4661
Practice Address - Fax:971-288-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty