Healthcare Provider Details

I. General information

NPI: 1467395442
Provider Name (Legal Business Name): CREATING CONQUERORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SW HAILEY AVE
PENDLETON OR
97801
US

IV. Provider business mailing address

71687 SW LAKE DR
PENDLETON OR
97801-9578
US

V. Phone/Fax

Practice location:
  • Phone: 541-561-1613
  • Fax:
Mailing address:
  • Phone: 541-561-1613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: KARL SHAYNE ARNDT
Title or Position: FOUNDER & CEO
Credential: CADC III, CPS
Phone: 541-561-1613