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General NPI Number Information
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NPI Number | 1285508101
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Entity Type | Organization
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Legal Business Name | EVERTIDE COUNSELING LLC
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 49280 HIGHWAY 101
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City | BANDON
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State | OR
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Zip | 97411-8225
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Country | US
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Telephone | 435-256-1965
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Fax | 541-275-1220
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Provider Business Mailing Address
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Address Line | 49280 HIGHWAY 101
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City | BANDON
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State | OR
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Zip | 97411-8225
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Country | US
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Telephone | 435-256-1965
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Fax | 541-275-1220
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MERRI LYNNE SEEGRIST
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Credential | LCSW
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Telephone | 435-256-1965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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