Provider Demographics
NPI:1033770938
Name:KIDS & COMPANY COUNSELING, INC
Entity type:Organization
Organization Name:KIDS & COMPANY COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-817-5326
Mailing Address - Street 1:1813 W HARVARD AVE STE 427
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8712
Mailing Address - Country:US
Mailing Address - Phone:541-817-5326
Mailing Address - Fax:
Practice Address - Street 1:1813 W HARVARD AVE STE 427
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8712
Practice Address - Country:US
Practice Address - Phone:907-545-3079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-22
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPCOP933OtherPROFESSIONAL COUNSELOR LICENSE
OR500733657Medicaid
WALH60275886OtherMENTAL HEALTH COUNSELOR LICENSE
ORC4751OtherPROFESSIONAL COUNSELOR LICENSE