Healthcare Provider Details

I. General information

NPI: 1881514420
Provider Name (Legal Business Name): HARBOR & PINE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 THOMPSON RD STE H
COOS BAY OR
97420-2040
US

IV. Provider business mailing address

1957 THOMPSON RD STE H
COOS BAY OR
97420-2040
US

V. Phone/Fax

Practice location:
  • Phone: 458-710-8776
  • Fax:
Mailing address:
  • Phone: 458-710-8776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN ALEXANDER LA MAR
Title or Position: OWNER
Credential: LCSW
Phone: 458-710-8776