Provider Demographics
NPI:1215644133
Name:ELEMENTS COUNSELING, WELLNESS, AND TRAINING INSTITUTE, LLC
Entity type:Organization
Organization Name:ELEMENTS COUNSELING, WELLNESS, AND TRAINING INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEFEO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-699-1083
Mailing Address - Street 1:354 NE GREENWOOD AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4632
Mailing Address - Country:US
Mailing Address - Phone:541-699-1083
Mailing Address - Fax:
Practice Address - Street 1:354 NE GREENWOOD AVE STE 204
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4632
Practice Address - Country:US
Practice Address - Phone:541-699-1083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty