Provider Demographics
NPI:1770024606
Name:PACIFIC COUNSELING SERVICES
Entity Type:Organization
Organization Name:PACIFIC COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSCKOWFF
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:541-283-5919
Mailing Address - Street 1:607 SW HURBERT ST
Mailing Address - Street 2:103
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4998
Mailing Address - Country:US
Mailing Address - Phone:541-283-5919
Mailing Address - Fax:541-272-5544
Practice Address - Street 1:607 SW HURBERT ST
Practice Address - Street 2:103
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4998
Practice Address - Country:US
Practice Address - Phone:541-283-5919
Practice Address - Fax:541-272-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2691251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health