Provider Demographics
NPI:1508587825
Name:THUNDEREGG COUNSELING LLC
Entity Type:Organization
Organization Name:THUNDEREGG COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER/OWNER/OPERATOR/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MACLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:CRC, NCC
Authorized Official - Phone:503-420-7494
Mailing Address - Street 1:PO BOX 14484
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97293-0484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1916 SW MADISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1718
Practice Address - Country:US
Practice Address - Phone:502-420-7494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)