Healthcare Provider Details

I. General information

NPI: 1700545522
Provider Name (Legal Business Name): MARBLE COUNSELING & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 SW CENTURY DR STE 100-5038
BEND OR
97702-3557
US

IV. Provider business mailing address

70 SW CENTURY DRIVE STE. 100 PMB 5038
BEND OR
97702
US

V. Phone/Fax

Practice location:
  • Phone: 541-668-6141
  • Fax: 541-236-0332
Mailing address:
  • Phone: 541-668-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1700545522
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerNPI2
# 2
Identifier500802970
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: RACHAEL MARBLE LEARY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA, LPC
Phone: 541-668-6141