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General NPI Number Information
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NPI Number | 1275222739
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Entity Type | Organization
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Legal Business Name | WEDNESDAYS COUNSELING SERVICES
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Dates
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Enumeration Date | 05/02/2023
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 235 SE YEW LN UNIT G
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City | BEND
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State | OR
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Zip | 97702-1607
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Country | US
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Telephone | 541-546-4267
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8234
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City | BEND
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State | OR
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Zip | 97708-8234
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Country | US
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Telephone | 541-546-4267
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MR. GREGGORY BRYAN MCVICKER
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Credential | LPC-A
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Telephone | 541-546-4267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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