Provider Demographics
NPI:1821683749
Name:KIANA KURZYNOWSKI LPC LLC
Entity Type:Organization
Organization Name:KIANA KURZYNOWSKI LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOLENE
Authorized Official - Middle Name:KIANA
Authorized Official - Last Name:KURZYNOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:808-633-1386
Mailing Address - Street 1:63427 DESCHUTES MARKET RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8813
Mailing Address - Country:US
Mailing Address - Phone:808-633-1386
Mailing Address - Fax:
Practice Address - Street 1:5 NW FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2905
Practice Address - Country:US
Practice Address - Phone:541-610-8826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC5862OtherLPC LICENSE NUMBER
OR500712217Medicaid