Healthcare Provider Details

I. General information

NPI: 1255014312
Provider Name (Legal Business Name): ELEMENTS OF HOPE AND HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 N 8TH ST
COTTAGE GROVE OR
97424-2025
US

IV. Provider business mailing address

34392 GAROUTTE RD
COTTAGE GROVE OR
97424-8538
US

V. Phone/Fax

Practice location:
  • Phone: 541-270-0434
  • Fax:
Mailing address:
  • Phone: 541-270-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRENDA HANSON THIELMAN
Title or Position: CEO / FOUNDER
Credential: LPC
Phone: 541-270-0434