Healthcare Provider Details

I. General information

NPI: 1285510198
Provider Name (Legal Business Name): WILLOW LIGHT COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 S MACADAM AVE STE N
PORTLAND OR
97239-6106
US

IV. Provider business mailing address

PO BOX 327
WEST LINN OR
97068-0327
US

V. Phone/Fax

Practice location:
  • Phone: 971-501-0357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAMANDIP JONES
Title or Position: PROFESSIONAL COUNSELOR ASSOCIATE
Credential:
Phone: 971-501-0357