Healthcare Provider Details

I. General information

NPI: 1306239819
Provider Name (Legal Business Name): COMPLETE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2015
Last Update Date: 03/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SE REED MARKET RD SUITE 270
BEND OR
97702-2237
US

IV. Provider business mailing address

300 SE REED MARKET RD SUITE 270
BEND OR
97702-2237
US

V. Phone/Fax

Practice location:
  • Phone: 541-350-5518
  • Fax: 541-408-9163
Mailing address:
  • Phone: 541-350-5518
  • Fax: 541-408-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
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: NANCY MOONEY
Title or Position: CREDENTIALING COORDINTAOR
Credential:
Phone: 541-350-5184