Provider Demographics
NPI:1205690625
Name:ASSEMBLAGE COUNSELING, LLC
Entity type:Organization
Organization Name:ASSEMBLAGE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:OTANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-810-2695
Mailing Address - Street 1:222 SE URANIA LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1624
Mailing Address - Country:US
Mailing Address - Phone:541-316-0033
Mailing Address - Fax:
Practice Address - Street 1:222 SE URANIA LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1624
Practice Address - Country:US
Practice Address - Phone:541-316-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty