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General NPI Number Information
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NPI Number | 1457044273
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Entity Type | Organization
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Legal Business Name | WALDEN PROJECT, LLC
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Dates
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Enumeration Date | 05/29/2023
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 3060 HIGHWAY 20
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City | NEWPORT
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State | OR
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Zip | 97365-9519
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Country | US
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Telephone | 541-992-3309
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Fax |
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Provider Business Mailing Address
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Address Line | 322 LEISURE LN
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City | SILETZ
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State | OR
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Zip | 97380-9620
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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 | BENJAMIN WILLIAMS
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Credential | LPC
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Telephone | 541-992-3309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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