Healthcare Provider Details

I. General information

NPI: 1235867680
Provider Name (Legal Business Name): TIMBERLINE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1394 KUBLI RD
GRANTS PASS OR
97527-8632
US

IV. Provider business mailing address

1394 KUBLI RD
GRANTS PASS OR
97527-8632
US

V. Phone/Fax

Practice location:
  • Phone: 541-842-0907
  • Fax:
Mailing address:
  • Phone: 541-842-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. KARL A HAECKLER
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCSW, DBH, BCD
Phone: 541-842-0907