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General NPI Number Information
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NPI Number | 1255251823
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Entity Type | Organization
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Legal Business Name | MENDING WATERS COUNSELING LLC
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 21850 HIGHWAY 62 # 200
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City | SHADY COVE
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State | OR
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Zip | 97539-8715
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Country | US
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Telephone | 541-241-2105
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1463
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City | SHADY COVE
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State | OR
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Zip | 97539-1463
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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 | RYAN PRICE
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Credential |
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Telephone | 541-241-2105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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