Provider Demographics
NPI:1467011577
Name:SHEARWATER COUNSELING SERVICES
Entity Type:Organization
Organization Name:SHEARWATER COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FADRIQUELA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:971-351-0485
Mailing Address - Street 1:2980 SW 123RD AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1325
Mailing Address - Country:US
Mailing Address - Phone:808-281-4616
Mailing Address - Fax:937-544-4009
Practice Address - Street 1:510 SW 3RD AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2507
Practice Address - Country:US
Practice Address - Phone:808-281-4616
Practice Address - Fax:937-544-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty