Provider Demographics
NPI:1568739944
Name:HOOD RIVER COUNSELING, PC
Entity Type:Organization
Organization Name:HOOD RIVER COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC-III
Authorized Official - Phone:541-490-7399
Mailing Address - Street 1:704 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1720
Mailing Address - Country:US
Mailing Address - Phone:541-490-7399
Mailing Address - Fax:503-914-6678
Practice Address - Street 1:704 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1720
Practice Address - Country:US
Practice Address - Phone:541-490-7399
Practice Address - Fax:503-914-6678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08-R-15101YA0400X
ORL44721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500637076Medicaid
ORR162480Medicare PIN