Healthcare Provider Details

I. General information

NPI: 1184800187
Provider Name (Legal Business Name): RESOLUTIONS CREATIVE CONFLICT MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 NE 4TH ST
BEND OR
97701-3825
US

IV. Provider business mailing address

2052 NE 4TH ST
BEND OR
97701-3825
US

V. Phone/Fax

Practice location:
  • Phone: 541-383-2004
  • Fax: 541-383-2013
Mailing address:
  • Phone: 541-383-2004
  • Fax: 541-383-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberL3785
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier1245241397
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerNPI FOR BETTY GROSHONG

VIII. Authorized Official

Name: BETTY JO GROSHONG
Title or Position: THERAPIST
Credential: LCSW
Phone: 541-383-2004