Provider Demographics
NPI:1871313254
Name:INDIGO COUNSELING LLC
Entity type:Organization
Organization Name:INDIGO COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-754-8941
Mailing Address - Street 1:1907 LINDA LN
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-3339
Mailing Address - Country:US
Mailing Address - Phone:503-754-8941
Mailing Address - Fax:541-612-5322
Practice Address - Street 1:1907 LINDA LN
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-3339
Practice Address - Country:US
Practice Address - Phone:503-754-8941
Practice Address - Fax:541-612-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty