Healthcare Provider Details

I. General information

NPI: 1508772278
Provider Name (Legal Business Name): ADVANCED TRAUMA COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 N MAIN ST
HEPPNER OR
97836-5001
US

IV. Provider business mailing address

850 LAKEVIEW CT
HEPPNER OR
97836-6389
US

V. Phone/Fax

Practice location:
  • Phone: 541-626-6611
  • Fax:
Mailing address:
  • Phone: 541-626-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER GEORGE HUMPHREYS
Title or Position: OWNER/MANAGER
Credential: LPC
Phone: 541-626-6611