Provider Demographics
NPI:1356374706
Name:POSITIVE POTENTIAL
Entity type:Organization
Organization Name:POSITIVE POTENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-312-3090
Mailing Address - Street 1:336 NE NORTON AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4350
Mailing Address - Country:US
Mailing Address - Phone:541-312-3090
Mailing Address - Fax:541-317-8488
Practice Address - Street 1:336 NE NORTON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4350
Practice Address - Country:US
Practice Address - Phone:541-312-3090
Practice Address - Fax:541-317-8488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL31161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty