Provider Demographics
NPI:1477261170
Name:AVID COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:AVID COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-900-8244
Mailing Address - Street 1:3806 TILLICUM LN
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2271
Mailing Address - Country:US
Mailing Address - Phone:541-900-8244
Mailing Address - Fax:
Practice Address - Street 1:3806 TILLICUM LN
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2271
Practice Address - Country:US
Practice Address - Phone:541-900-8244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health