Provider Demographics
NPI:1225401151
Name:SERENITY COUNSELING PC
Entity Type:Organization
Organization Name:SERENITY COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-969-4070
Mailing Address - Street 1:1253 STONEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MILTON FREEWATER
Mailing Address - State:OR
Mailing Address - Zip Code:97862-1067
Mailing Address - Country:US
Mailing Address - Phone:541-969-4070
Mailing Address - Fax:541-215-1718
Practice Address - Street 1:1253 STONEWOOD CT
Practice Address - Street 2:
Practice Address - City:MILTON FREEWATER
Practice Address - State:OR
Practice Address - Zip Code:97862-1067
Practice Address - Country:US
Practice Address - Phone:541-969-4070
Practice Address - Fax:541-215-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR115331191251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225401151OtherMEDICARE