Provider Demographics
NPI:1629602404
Name:OREGON CITY COUNSELING, LLC
Entity Type:Organization
Organization Name:OREGON CITY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SLADE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-891-6200
Mailing Address - Street 1:18616 S GRASLE RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-8898
Mailing Address - Country:US
Mailing Address - Phone:503-891-6200
Mailing Address - Fax:
Practice Address - Street 1:714 MAIN ST STE B207
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1826
Practice Address - Country:US
Practice Address - Phone:503-891-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty