Provider Demographics
NPI:1982199683
Name:WESTWIND COUNSELING LLC
Entity Type:Organization
Organization Name:WESTWIND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLONICA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-224-1684
Mailing Address - Street 1:2396 NW KINGS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3984
Mailing Address - Country:US
Mailing Address - Phone:541-224-1684
Mailing Address - Fax:
Practice Address - Street 1:2396 NW KINGS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3984
Practice Address - Country:US
Practice Address - Phone:541-224-1684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL74041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty