Provider Demographics
NPI:1649861105
Name:ONYX COUNSELING CONSULTING & SUPERVISION, LLC.
Entity type:Organization
Organization Name:ONYX COUNSELING CONSULTING & SUPERVISION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLIE
Authorized Official - Middle Name:REIKO
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-638-0841
Mailing Address - Street 1:1767 12TH ST # 259
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-9531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1767 12TH ST # 259
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-9531
Practice Address - Country:US
Practice Address - Phone:541-638-0841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1083124697Medicaid