Healthcare Provider Details

I. General information

NPI: 1568213338
Provider Name (Legal Business Name): CLOUD GARDEN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 NE ROBERTS AVE STE 200
GRESHAM OR
97030-7484
US

IV. Provider business mailing address

510 NE ROBERTS AVE STE 200
GRESHAM OR
97030-7484
US

V. Phone/Fax

Practice location:
  • Phone: 503-799-8819
  • Fax:
Mailing address:
  • Phone: 503-799-8819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIFFANY RAE BARR
Title or Position: PROFESSIONAL COUNSELOR ASSOCIATE
Credential:
Phone: 503-799-8819