Healthcare Provider Details

I. General information

NPI: 1407328701
Provider Name (Legal Business Name): LIFE DISCOVERY COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 E MAIN ST
HILLSBORO OR
97123-7168
US

IV. Provider business mailing address

7320 SW HUNZIKER RD STE 204
TIGARD OR
97223-2301
US

V. Phone/Fax

Practice location:
  • Phone: 971-808-2686
  • Fax:
Mailing address:
  • Phone: 503-706-6426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NARTHAN HAWKINS
Title or Position: OWNER
Credential:
Phone: 503-706-6426