MEDICARE: SPIRO HEALING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801100769	MI

General Provider Information

NPI Number	:	1851801575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPIRO HEALING LLC

Provider Business Mailing Address
First Line	:	2504 LIBERTY ST
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-3230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2504 LIBERTY ST
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-3230
Country	:	US
Telephone Number	:	720-556-2449
Fax Number	:

Authorized Official
Title or Position	:	OWNER & PROVIDER
Name	:	MALISSA TROJAN
Credential	:	LCSW, CCTP
Telephone Number	:	720-556-2449

Provider Enumeration Date	:	10/08/2017
Last Update Date	:	04/29/2021

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Directions to “SPIRO HEALING LLC ” Practice Location

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