Provider Demographics
NPI:1326860628
Name:VICTOR COUNSELING AND CONSULTATION
Entity type:Organization
Organization Name:VICTOR COUNSELING AND CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOMER-JENKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:971-940-0387
Mailing Address - Street 1:888 SE 9TH AVE APT 420
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2250
Mailing Address - Country:US
Mailing Address - Phone:971-940-0387
Mailing Address - Fax:
Practice Address - Street 1:888 SE 9TH AVE APT 420
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2250
Practice Address - Country:US
Practice Address - Phone:971-940-0387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health