Provider Demographics
NPI:1205618451
Name:HEALING FOR THE CULTURE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:HEALING FOR THE CULTURE COUNSELING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-688-8066
Mailing Address - Street 1:123 NW 12TH AVE APT 434
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-4146
Mailing Address - Country:US
Mailing Address - Phone:540-688-8066
Mailing Address - Fax:
Practice Address - Street 1:123 NW 12TH AVE APT 434
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-4146
Practice Address - Country:US
Practice Address - Phone:540-688-8066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service