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General NPI Number Information
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NPI Number | 1932647104
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Entity Type | Organization
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Legal Business Name | WATERFALL COUNSELING, LLC
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 215 E MAIN ST
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City | MOLALLA
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State | OR
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Zip | 97038-8128
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Country | US
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Telephone | 503-862-8145
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Fax |
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Provider Business Mailing Address
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Address Line | 601 MAY ST
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City | MOLALLA
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State | OR
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Zip | 97038-8108
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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 | MEMBER/MANAGER
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Name | CYNTHIA COX
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Credential | M.A.
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Telephone | 503-862-8145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | R4640
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License Number State | OR
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