Healthcare Provider Details

I. General information

NPI: 1740654102
Provider Name (Legal Business Name): LARKSPUR WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 NW SAGINAW AVE
BEND OR
97703
US

IV. Provider business mailing address

70 SW CENTURY DR AUITE 100-281
BEND OR
97702
US

V. Phone/Fax

Practice location:
  • Phone: 503-708-2310
  • Fax:
Mailing address:
  • Phone: 503-708-2310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number9064567
License Number StateOR

VIII. Authorized Official

Name: ALLISON BARNARD
Title or Position: OWNER AND DIRECTOR
Credential: ACC, CPC
Phone: 541-261-6413