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General NPI Number Information
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NPI Number | 1356047047
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Entity Type | Organization
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Legal Business Name | MOUNTAIN RIVER COUNSELING AND CONSULTING LLC
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Dates
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Enumeration Date | 02/03/2023
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 20273 REED LN
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City | BEND
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State | OR
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Zip | 97702
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Country | US
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Telephone | 425-654-0424
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Fax |
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Provider Business Mailing Address
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Address Line | 61141 S HWY 97 # 226
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City | BEND
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State | OR
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Zip | 97702-2523
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Country | US
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Telephone | 425-654-0424
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD EWE
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Credential | PHD
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Telephone | 425-654-0424
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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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