Provider Demographics
NPI:1336677988
Name:WOLF PACK CONSULTING AND THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:WOLF PACK CONSULTING AND THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TONGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-908-5287
Mailing Address - Street 1:16055 SW WALKER RD # 443
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4942
Mailing Address - Country:US
Mailing Address - Phone:971-344-3844
Mailing Address - Fax:
Practice Address - Street 1:16365 NW TWIN OAKS DR.
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4741
Practice Address - Country:US
Practice Address - Phone:415-908-5287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-26
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL4228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty