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General NPI Number Information
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NPI Number | 1477261170
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Entity Type | Organization
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Legal Business Name | AVID COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 11/10/2022
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 3806 TILLICUM LN
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City | ROSEBURG
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State | OR
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Zip | 97471-2271
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Country | US
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Telephone | 541-900-8244
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Fax |
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Provider Business Mailing Address
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Address Line | 3806 TILLICUM LN
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City | ROSEBURG
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State | OR
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Zip | 97471-2271
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Country | US
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Telephone | 541-900-8244
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | JASON WILCOX
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Credential | LCSW
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Telephone | 541-900-8244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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