Quiet Waters Counseling LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

QUIET WATERS COUNSELING LLC

Practice address

1277 SE Shelton St
Dallas, OR 97338-2537

Phone

(458) 233-3136

Fax

(800) 433-1396

NPI assigned

Mar 26, 2024

Last updated

Mar 26, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberli Ann Wicks, LPC

Title

Owner

Phone

(458) 233-3136

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kimberli Ann Krenik, LPC

  • Mental Health Counselor
  • Dallas, OR
  • NPI 1649487927
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1609626076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1787",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975010261",
            "telephone_number": "541-500-8655",
            "fax_number": "800-433-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1277 SE SHELTON ST",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973382537",
            "telephone_number": "458-233-3136",
            "fax_number": "800-433-1396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUIET WATERS COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-26",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A",
        "authorized_official_last_name": "WICKS",
        "authorized_official_first_name": "KIMBERLI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "458-233-3136",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Joy Porter, LMT
• Lyndsay Marie Posey, L.AC.
• Praxis Health, PC (Dallas Family Care)
• Prestigious Corporation
• David Proffitt
• Jennifer Reavis
• Aisha R Redl-Sherwood
• Lilliana Raven Redman, NCPT
• Justin W Reed
• Gina P Remington, M.D.

• Professional Counselor in Dallas, OR
• Providers in Dallas, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.