Healthcare Provider Details

I. General information

NPI: 1467695940
Provider Name (Legal Business Name): CORCONCEPTS COUNSELING & ENRICHMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 NE 7TH ST SUITE A
BEND OR
97701-4511
US

IV. Provider business mailing address

1034 NE 7TH ST SUITE A
BEND OR
97701-4511
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-5031
  • Fax: 541-389-3246
Mailing address:
  • Phone: 541-389-5031
  • Fax: 541-389-3246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number251S00000X
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. ANNA MARIE SONNENBURG
Title or Position: EXECUTIVE DIRECTOR
Credential: L.P.C.
Phone: 541-389-5031