Healthcare Provider Details

I. General information

NPI: 1538874979
Provider Name (Legal Business Name): ECOWELLNESS COUNSELING & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 NW WALL ST
BEND OR
97703-2052
US

IV. Provider business mailing address

925 NW WALL ST
BEND OR
97703-2052
US

V. Phone/Fax

Practice location:
  • Phone: 541-241-6575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. RYAN F REESE
Title or Position: OWNER
Credential: PHD
Phone: 541-241-6575