Healthcare Provider Details

I. General information

NPI: 1003748898
Provider Name (Legal Business Name): LIFE ALCHEMY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 NW 167TH PL STE 100-38
BEAVERTON OR
97006-4908
US

IV. Provider business mailing address

1975 NW 167TH PL STE 100-38
BEAVERTON OR
97006-4908
US

V. Phone/Fax

Practice location:
  • Phone: 503-567-6499
  • Fax:
Mailing address:
  • Phone: 503-567-6499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. KIAN KOLAHI
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LCSW
Phone: 503-567-6499