Provider Demographics
NPI:1942848353
Name:EASTSIDE COUNSELING LLC
Entity Type:Organization
Organization Name:EASTSIDE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAROLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-968-6624
Mailing Address - Street 1:3234 NE WASCO ST STE G
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1981
Mailing Address - Country:US
Mailing Address - Phone:541-968-6624
Mailing Address - Fax:
Practice Address - Street 1:3234 NE WASCO ST STE G
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1981
Practice Address - Country:US
Practice Address - Phone:541-968-6624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty