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General NPI Number Information
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NPI Number | 1801641246
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Entity Type | Organization
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Legal Business Name | DEEP WATER COUNSELING
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Dates
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Enumeration Date | 04/19/2024
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 128 W ANTLER AVE
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City | REDMOND
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State | OR
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Zip | 97756-1852
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Country | US
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Telephone | 541-604-2646
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Fax |
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Provider Business Mailing Address
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Address Line | 915 SW RIMROCK WAY # 201-271
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City | REDMOND
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State | OR
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Zip | 97756-2570
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Country | US
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Telephone | 541-604-2646
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHERRY Y MACIAS
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Credential | LPC
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Telephone | 541-604-2646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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