Provider Demographics
NPI:1760859227
Name:A SEASON FOR CHANGE
Entity Type:Organization
Organization Name:A SEASON FOR CHANGE
Other - Org Name:A SEASON FOR CHANGE COUNSELING AND HYPNOSIS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOWLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-997-7734
Mailing Address - Street 1:39085 PIONEER BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-8062
Mailing Address - Country:US
Mailing Address - Phone:503-997-7734
Mailing Address - Fax:
Practice Address - Street 1:1122 SW 257TH AVE
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-1474
Practice Address - Country:US
Practice Address - Phone:503-997-7734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR97733399251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health