Provider Demographics
NPI:1578146106
Name:HEALING TIDES COUNSELING, LLC
Entity Type:Organization
Organization Name:HEALING TIDES COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANAKO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVOLL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-887-6255
Mailing Address - Street 1:3439 NE SANDY BLVD # 313
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1959
Mailing Address - Country:US
Mailing Address - Phone:503-887-6255
Mailing Address - Fax:503-212-0969
Practice Address - Street 1:2450 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2821
Practice Address - Country:US
Practice Address - Phone:503-887-2555
Practice Address - Fax:503-212-0969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-02
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty