| Quiet Waters Counseling Llc | |
|
1277 Se Shelton St Dallas OR 97338-2537 | |
| (458) 233-3136 | |
| (800) 433-1396 |
| Full Name | Quiet Waters Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 1277 Se Shelton St, Dallas, Oregon |
| Authorized Official Name and Position | Kimberli Ann Wicks (OWNER) |
| Authorized Official Contact | 4582333136 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Quiet Waters Counseling Llc Po Box 1787 Medford OR 97501-0261 Ph: (541) 500-8655 | Quiet Waters Counseling Llc 1277 Se Shelton St Dallas OR 97338-2537 Ph: (458) 233-3136 |
| NPI Number | 1609626076 |
|---|---|
| Provider Enumeration Date | 03/26/2024 |
| Last Update Date | 03/26/2024 |
| Certification Date | 03/26/2024 |
| Medicare PECOS PAC ID | 2062949142 |
|---|---|
| Medicare Enrollment ID | O20241231003537 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609626076 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Kimberli Ann Wicks |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649487927 PECOS PAC ID: 6204275019 Enrollment ID: I20240412002234 |
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