Provider Demographics
NPI:1437137312
Name:COUNSELING NORTHWEST, LLC
Entity Type:Organization
Organization Name:COUNSELING NORTHWEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BLANDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFC
Authorized Official - Phone:541-773-7503
Mailing Address - Street 1:PO BOX 1799
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-1799
Mailing Address - Country:US
Mailing Address - Phone:541-776-7601
Mailing Address - Fax:541-776-3007
Practice Address - Street 1:916 W 10TH STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501
Practice Address - Country:US
Practice Address - Phone:541-773-7503
Practice Address - Fax:541-776-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-02
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNONE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty