MEDICARE: CO-OCCURRING THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1871274746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CO-OCCURRING THERAPY, LLC

Provider Business Mailing Address
First Line	:	13203 SE 172ND AVE STE 166
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-8738
Country	:	US
Telephone Number	:	971-421-7718
Fax Number	:

Provider Business Practice Location Address
First Line	:	13157 SE 132ND AVE
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-9354
Country	:	US
Telephone Number	:	971-421-7718
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS LISA RAE FRANCIS
Credential	:	LCSW LICSW
Telephone Number	:	971-421-7718

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	07/25/2023

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