Provider Demographics
NPI:1508672635
Name:OWADALEN LLC
Entity type:Organization
Organization Name:OWADALEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARREDONDO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-973-7752
Mailing Address - Street 1:141 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-6656
Mailing Address - Country:US
Mailing Address - Phone:541-973-7752
Mailing Address - Fax:
Practice Address - Street 1:141 N FRONT ST
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-6656
Practice Address - Country:US
Practice Address - Phone:541-973-7752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty