Healthcare Provider Details

I. General information

NPI: 1184103301
Provider Name (Legal Business Name): B.H. COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NE 7TH ST STE C
GRANTS PASS OR
97526
US

IV. Provider business mailing address

1201 NE 7TH ST STE C
GRANTS PASS OR
97526-1451
US

V. Phone/Fax

Practice location:
  • Phone: 541-890-1965
  • Fax:
Mailing address:
  • Phone: 541-890-1965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier500679509
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: BRYAN LEE HATHAWAY
Title or Position: ADMINISTRATOR
Credential: MS, LPC
Phone: 541-890-1965