Provider Demographics
NPI:1942701271
Name:WINDING TREE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:WINDING TREE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOAL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-690-8003
Mailing Address - Street 1:1367 LAWNRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6245
Mailing Address - Country:US
Mailing Address - Phone:978-602-2094
Mailing Address - Fax:
Practice Address - Street 1:916 W 10TH ST STE 100
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3018
Practice Address - Country:US
Practice Address - Phone:541-690-8003
Practice Address - Fax:541-843-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4092101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty