Healthcare Provider Details

I. General information

NPI: 1730987736
Provider Name (Legal Business Name): BASECAMP COUNSELING & CONSULTING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 NE NORTON AVE STE 1
BEND OR
97701-4386
US

IV. Provider business mailing address

336 NE NORTON AVE STE 1
BEND OR
97701-4386
US

V. Phone/Fax

Practice location:
  • Phone: 541-797-3657
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH HARRIS
Title or Position: OWNER
Credential: PHD
Phone: 541-215-4407