Healthcare Provider Details

I. General information

NPI: 1528531100
Provider Name (Legal Business Name): A BETTER REALITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 N. 17TH SSTREET
COOS BAY OR
97420
US

IV. Provider business mailing address

69766 DEL VIEW LN
NORTH BEND OR
97459-7781
US

V. Phone/Fax

Practice location:
  • Phone: 541-269-8133
  • Fax:
Mailing address:
  • Phone: 541-217-8762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DANIEL EMMETT
Title or Position: OWNER
Credential: PHD
Phone: 541-269-8133