Provider Demographics
NPI:1972216877
Name:FJORD COUNSELING LLC
Entity Type:Organization
Organization Name:FJORD COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:B
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC III
Authorized Official - Phone:541-954-3485
Mailing Address - Street 1:PO BOX 40142
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-0020
Mailing Address - Country:US
Mailing Address - Phone:541-234-3090
Mailing Address - Fax:
Practice Address - Street 1:1355 W 13TH AVE.
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3955
Practice Address - Country:US
Practice Address - Phone:541-234-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500731705Medicaid
OR500725923Medicaid