Healthcare Provider Details

I. General information

NPI: 1922516160
Provider Name (Legal Business Name): HOPE STOREY, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SW 8TH ST
REDMOND OR
97756-2114
US

IV. Provider business mailing address

4528 SW 39TH ST
REDMOND OR
97756-9461
US

V. Phone/Fax

Practice location:
  • Phone: 541-279-5781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberL4187
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberL4187
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberL4187
License Number StateOR

VIII. Authorized Official

Name: HOPE STOREY
Title or Position: OWNER/OPERATOR
Credential: LCSW
Phone: 541-279-5781