Provider Demographics
NPI:1316584386
Name:NEW TIDES COUNSELING AND WELLNESS
Entity Type:Organization
Organization Name:NEW TIDES COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CHENEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-241-6445
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-0041
Mailing Address - Country:US
Mailing Address - Phone:541-241-6445
Mailing Address - Fax:855-291-0906
Practice Address - Street 1:2863 NW CROSSING DR STE 217
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7190
Practice Address - Country:US
Practice Address - Phone:541-241-6445
Practice Address - Fax:855-291-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty