Provider Demographics
NPI:1801641246
Name:DEEP WATER COUNSELING
Entity type:Organization
Organization Name:DEEP WATER COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-604-2646
Mailing Address - Street 1:915 SW RIMROCK WAY # 201-271
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2570
Mailing Address - Country:US
Mailing Address - Phone:541-604-2646
Mailing Address - Fax:
Practice Address - Street 1:128 W ANTLER AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1852
Practice Address - Country:US
Practice Address - Phone:541-604-2646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty