Basic Information
| Provider Information | |||||||||
| NPI: | 1609447796 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | URSA MAJOR COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 NW 20TH AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972091452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039743330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 811 NW 20TH AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972091452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088663426 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2021 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | HUTCHENS | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 0359743330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC, CADC | ||||||||
| NPICertificationDate: | 08/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.