Healthcare Provider Details

I. General information

NPI: 1619581931
Provider Name (Legal Business Name): WHALESONG COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/19/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SE 9TH ST STE 1AND2
LINCOLN CITY OR
97367-2618
US

IV. Provider business mailing address

1616 SW 36TH ST
LINCOLN CITY OR
97367
US

V. Phone/Fax

Practice location:
  • Phone: 541-614-0294
  • Fax: 360-844-5184
Mailing address:
  • Phone: 971-301-4666
  • Fax: 360-844-5184

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

VIII. Authorized Official

Name: AMY YOUNG
Title or Position: OFFICE MANAGER/ADMINISTRATOR
Credential:
Phone: 360-210-7301