1649045261 NPI number — CLIMBING MOUNTAINS COUNSELING LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649045261 NPI number — CLIMBING MOUNTAINS COUNSELING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLIMBING MOUNTAINS COUNSELING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649045261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
775 SW MADISON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADRAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97741-1028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-866-4642
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
775 SW MADISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADRAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97741-1028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-866-4642
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/24/2023

Additional Information

Authorized Official

Authorized Official Last Name:
VERA GONZALEZ
Authorized Official First Name:
PATRICIA IRMA
Authorized Official Middle Name:
IRMA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
503-866-4642

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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