Provider Demographics
NPI:1235682360
Name:TREE OF LIFE CHRISTIAN WILDERNESS EXPEDITIONS
Entity Type:Organization
Organization Name:TREE OF LIFE CHRISTIAN WILDERNESS EXPEDITIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:YAHNE
Authorized Official - Suffix:
Authorized Official - Credentials:MAC,CADC III
Authorized Official - Phone:541-281-2956
Mailing Address - Street 1:PO BOX 1035
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-0392
Mailing Address - Country:US
Mailing Address - Phone:541-281-2956
Mailing Address - Fax:
Practice Address - Street 1:5728 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-5108
Practice Address - Country:US
Practice Address - Phone:541-281-2956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR96-10-89101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty