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General NPI Number Information
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NPI Number | 1285260471
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Entity Type | Organization
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Legal Business Name | SUNDANCE COUNSELING WEST LLC
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 11/10/2023
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Provider Practice Location Address
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Address Line | 201 B AVE STE 295
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-3290
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Country | US
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Telephone | 503-616-1101
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Fax | 503-334-4379
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Provider Business Mailing Address
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Address Line | 17218 S RAMSBY RD
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City | MOLALLA
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State | OR
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Zip | 97038-7634
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Country | US
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Telephone | 503-616-1101
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Fax | 503-334-4379
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Authorized Official
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Title or Position | OWNER / PRACTITIONER
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Name | ALLISON BLOMQUIST CHRISTIANSON
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Credential | LCSW
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Telephone | 503-616-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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