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General NPI Number Information
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NPI Number | 1043080245
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Entity Type | Organization
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Legal Business Name | LIVING WATERS COUNSEL LLC
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 14376 SW FARMINGTON RD
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City | BEAVERTON
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State | OR
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Zip | 97005-2524
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Country | US
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Telephone | 503-567-7604
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Fax |
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Provider Business Mailing Address
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Address Line | 7018 SW 156TH AVE
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City | BEAVERTON
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State | OR
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Zip | 97007-6801
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ELYSIA CHAN
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Credential | MA
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Telephone | 510-282-6895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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