Healthcare Provider Details

I. General information

NPI: 1225339096
Provider Name (Legal Business Name): LEVONNE F KOUNTZ MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SW FRAZER AVE
PENDLETON OR
97801-2800
US

IV. Provider business mailing address

PO BOX 694
PENDLETON OR
97801-0694
US

V. Phone/Fax

Practice location:
  • Phone: 541-304-5201
  • Fax: 360-844-5184
Mailing address:
  • Phone: 541-304-5201
  • Fax: 360-844-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberL5078
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: