Healthcare Provider Details

I. General information

NPI: 1336616077
Provider Name (Legal Business Name): ELLEN HESS MHC.LH.60704304
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2252 S 22ND CT
FLORENCE OR
97439-9788
US

IV. Provider business mailing address

2252 S 22ND CT
FLORENCE OR
97439-9788
US

V. Phone/Fax

Practice location:
  • Phone: 425-583-6410
  • Fax:
Mailing address:
  • Phone: 425-583-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.60704304
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC6985
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: