Healthcare Provider Details

I. General information

NPI: 1720485527
Provider Name (Legal Business Name): HEARTSONG COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 SW 2ND AVE. #203
ALBANY OR
97321
US

IV. Provider business mailing address

PO BOX 1175
ALBANY OR
97321-0432
US

V. Phone/Fax

Practice location:
  • Phone: 541-609-1701
  • Fax:
Mailing address:
  • Phone: 541-609-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. PATTI A. HEARTSONG
Title or Position: COUNSELOR
Credential: L.P.C.
Phone: 541-609-1701