Provider Demographics
NPI:1114898939
Name:PURA VIDA COUNSELING LLC
Entity type:Organization
Organization Name:PURA VIDA COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:P
Authorized Official - Last Name:DROLL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-205-9159
Mailing Address - Street 1:18891 CHOCTAW RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-7911
Mailing Address - Country:US
Mailing Address - Phone:541-205-9159
Mailing Address - Fax:949-703-7402
Practice Address - Street 1:45 NW GREELEY AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2943
Practice Address - Country:US
Practice Address - Phone:541-205-9159
Practice Address - Fax:949-703-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty