Provider Demographics
NPI:1659945202
Name:FREE SPIRIT COUNSELING LLC
Entity Type:Organization
Organization Name:FREE SPIRIT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-410-8713
Mailing Address - Street 1:16232 SW LOWER BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:TERREBONNE
Mailing Address - State:OR
Mailing Address - Zip Code:97760-9678
Mailing Address - Country:US
Mailing Address - Phone:541-316-0206
Mailing Address - Fax:
Practice Address - Street 1:9249 NW 31ST ST
Practice Address - Street 2:
Practice Address - City:TERREBONNE
Practice Address - State:OR
Practice Address - Zip Code:97760
Practice Address - Country:US
Practice Address - Phone:541-316-0206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500810955Medicaid