Provider Demographics
NPI: | 1568913028 |
---|---|
Name: | WILL WALKER LCISW LLC |
Entity Type: | Organization |
Organization Name: | WILL WALKER LCISW LLC |
Other - Org Name: | HOURGLASS COUNSELING |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | WILLIAM |
Authorized Official - Middle Name: | NOAH |
Authorized Official - Last Name: | WALKER |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | LCSW |
Authorized Official - Phone: | 503-438-0266 |
Mailing Address - Street 1: | 650 NE HOLLADAY ST |
Mailing Address - Street 2: | SUITE 1600 |
Mailing Address - City: | PORTLAND |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97232-2045 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 503-438-0266 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 650 NE HOLLADAY ST |
Practice Address - Street 2: | SUITE 1600 |
Practice Address - City: | PORTLAND |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97232-2045 |
Practice Address - Country: | US |
Practice Address - Phone: | 503-438-0266 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-10-20 |
Last Update Date: | 2017-06-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OR | 124827296 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |