Provider Demographics
NPI:1306528112
Name:CONSCIOUS CONNECTIONS YOUTH COUNSELING LLC
Entity type:Organization
Organization Name:CONSCIOUS CONNECTIONS YOUTH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCSW
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-238-2289
Mailing Address - Street 1:4542 COOPERS HAWK RD
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-9600
Mailing Address - Country:US
Mailing Address - Phone:541-891-3881
Mailing Address - Fax:
Practice Address - Street 1:905 MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6066
Practice Address - Country:US
Practice Address - Phone:541-238-2289
Practice Address - Fax:541-835-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty