| Organization Name: | WISTER PARK COUNSELING, LLC |
| NPI Number: | 1043683105 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BYRON W KEHLER (PRESIDENT) |
| Mailing Address: | 11630 Se 40th Ave Ste. A Milwaukie |
| State: | OR US |
| Postal Code: | 972226195 |
| Phone Number: | 5032779780 |
| Fax Number: | |
| NPI Enumeration Date: | 11/10/2015 |
| NPI Last Update Date: | 11/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |