Provider Demographics
NPI:1548748361
Name:DEEPER WELL PSYCHOTHERAPY AND COUNSELING, LLC
Entity Type:Organization
Organization Name:DEEPER WELL PSYCHOTHERAPY AND COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:831-331-5993
Mailing Address - Street 1:3316 SE HATHAWAY DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-9262
Mailing Address - Country:US
Mailing Address - Phone:831-331-5993
Mailing Address - Fax:
Practice Address - Street 1:120 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4724
Practice Address - Country:US
Practice Address - Phone:541-262-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1497192306Medicaid