Healthcare Provider Details

I. General information

NPI: 1720687676
Provider Name (Legal Business Name): BREE BURCH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 NE NORTON AVE STE 5
BEND OR
97701-4386
US

IV. Provider business mailing address

19781 BANEBERRY AVE
BEND OR
97702-3360
US

V. Phone/Fax

Practice location:
  • Phone: 541-306-0969
  • Fax:
Mailing address:
  • Phone: 541-306-0969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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:

VIII. Authorized Official

Name: BREE BURCH
Title or Position: OWNER/PROVIDER
Credential: LPC
Phone: 541-306-0969