Organization
NICK SUNDSTROM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS ERIC SUNDSTROM LCSW (OWNER/PROVIDER)
(541) 647-7820
Entity
Organization
Contact information
Practice address
2659 SW 4TH ST STE 110, REDMOND, OR 97756
(541) 647-7820
Mailing address
2659 SW 4TH ST STE 110, REDMOND, OR 97756-6406
(541) 647-7820
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
251S00000X
Community/Behavioral Health Agency
4413
OR
261QM0850X
Adult Mental Health Clinic/Center
4413
OR
Other
Enumeration date
03/19/2018
Last updated
10/05/2018
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