Provider Demographics
NPI:1376316877
Name:POUR OVER COUNSELING LLC
Entity Type:Organization
Organization Name:POUR OVER COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITHIOF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:979-220-7627
Mailing Address - Street 1:2167 NW LARCHLEAF LN
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1257
Mailing Address - Country:US
Mailing Address - Phone:979-220-7627
Mailing Address - Fax:
Practice Address - Street 1:625 NW COLORADO AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3257
Practice Address - Country:US
Practice Address - Phone:979-220-7627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty