Provider Demographics
NPI:1255850889
Name:PHILOMATH COUNSELING, LLC
Entity type:Organization
Organization Name:PHILOMATH COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-929-2878
Mailing Address - Street 1:PO BOX 1606
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-1606
Mailing Address - Country:US
Mailing Address - Phone:541-929-2878
Mailing Address - Fax:541-929-3770
Practice Address - Street 1:1229 MAIN ST. #105
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370
Practice Address - Country:US
Practice Address - Phone:541-929-2878
Practice Address - Fax:541-929-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL40971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR043278Medicaid