Healthcare Provider Details

I. General information

NPI: 1124607429
Provider Name (Legal Business Name): NORTHWEST COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 GLYNBROOK ST N
KEIZER OR
97303-5796
US

IV. Provider business mailing address

132 GLYNBROOK ST N
KEIZER OR
97303-5796
US

V. Phone/Fax

Practice location:
  • Phone: 971-227-9808
  • Fax:
Mailing address:
  • Phone:
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MUNI SHARON REDDY
Title or Position: OWNER
Credential: LPC, CADC
Phone: 971-227-9808