Provider Demographics
NPI:1205611084
Name:GOLDEN MOTH COUNSELING LLC
Entity type:Organization
Organization Name:GOLDEN MOTH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-757-9309
Mailing Address - Street 1:615 NW 2ND AVE UNIT 51
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-0800
Mailing Address - Country:US
Mailing Address - Phone:503-433-5368
Mailing Address - Fax:
Practice Address - Street 1:615 NW 2ND AVE UNIT 51
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-0800
Practice Address - Country:US
Practice Address - Phone:503-433-5368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health