Provider Demographics
NPI:1417428673
Name:FULL CIRCLE COUNSELING LLC
Entity Type:Organization
Organization Name:FULL CIRCLE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARTSHORN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-588-2113
Mailing Address - Street 1:PO BOX 1882
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-1882
Mailing Address - Country:US
Mailing Address - Phone:503-588-2113
Mailing Address - Fax:503-635-9127
Practice Address - Street 1:15100 BOONES FERRY RD STE 800C
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3469
Practice Address - Country:US
Practice Address - Phone:503-588-2112
Practice Address - Fax:503-635-9127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ES45CSCX.OtherIDENTIFICATION