Healthcare Provider Details

I. General information

NPI: 1003678137
Provider Name (Legal Business Name): CEDAR SPRINGS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61635 DALY ESTATES DR
BEND OR
97702-4203
US

IV. Provider business mailing address

61635 DALY ESTATES DR
BEND OR
97702-4203
US

V. Phone/Fax

Practice location:
  • Phone: 458-206-3999
  • Fax:
Mailing address:
  • Phone: 458-206-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: GREGORY LOGAN
Title or Position: OWNER
Credential: LPC
Phone: 458-206-3999