| Mountain River Counseling And Consulting Llc | |
|
1133 Nw Wall Street Suite 1 Es 8 Bend OR 97703 | |
| (425) 654-0424 | |
| Not Available |
| Full Name | Mountain River Counseling And Consulting Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1133 Nw Wall Street Suite 1 Es 8, Bend, Oregon |
| Authorized Official Name and Position | Edward Ewe (OWNER) |
| Authorized Official Contact | 4256540424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain River Counseling And Consulting Llc 61141 S Hwy 97 # 226 Bend OR 97702-2523 Ph: (425) 654-0424 | Mountain River Counseling And Consulting Llc 1133 Nw Wall Street Suite 1 Es 8 Bend OR 97703 Ph: (425) 654-0424 |
| NPI Number | 1356047047 |
|---|---|
| Provider Enumeration Date | 02/03/2023 |
| Last Update Date | 08/08/2024 |
| Certification Date | 08/08/2024 |
| Medicare PECOS PAC ID | 6507205614 |
|---|---|
| Medicare Enrollment ID | O20240422001304 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356047047 | NPI | - | NPPES |
| 500810109 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Edward Ewe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659591352 PECOS PAC ID: 7315386422 Enrollment ID: I20240422001506 |
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