Healthcare Provider Details

I. General information

NPI: 1124949623
Provider Name (Legal Business Name): AGAPE INTEGRATIVE PSYCHIATRY AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N 9TH ST
COTTAGE GROVE OR
97424-1310
US

IV. Provider business mailing address

323 N 9TH ST
COTTAGE GROVE OR
97424-1310
US

V. Phone/Fax

Practice location:
  • Phone: 541-214-7873
  • Fax:
Mailing address:
  • Phone: 541-214-7873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRONWEN FLORES
Title or Position: PROVIDER
Credential: PMHNP-BC
Phone: 541-214-7873