Provider Demographics
NPI:1922772011
Name:EMBARK COUNSELING NW, LLC
Entity Type:Organization
Organization Name:EMBARK COUNSELING NW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:JADE
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-422-7215
Mailing Address - Street 1:PO BOX 17558
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-0558
Mailing Address - Country:US
Mailing Address - Phone:503-422-7215
Mailing Address - Fax:971-339-8491
Practice Address - Street 1:15220 NW LAIDLAW RD STE 240
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-7718
Practice Address - Country:US
Practice Address - Phone:503-422-7215
Practice Address - Fax:971-339-8491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty