Provider Demographics
NPI:1588182984
Name:WATER CUP COUNSELING
Entity Type:Organization
Organization Name:WATER CUP COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT THERAPIST.
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GRIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:541-527-5802
Mailing Address - Street 1:2318 SE JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-8891
Mailing Address - Country:US
Mailing Address - Phone:541-527-5802
Mailing Address - Fax:
Practice Address - Street 1:852 SW 15TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2507
Practice Address - Country:US
Practice Address - Phone:541-527-5802
Practice Address - Fax:541-526-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-1233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty