Healthcare Provider Details

I. General information

NPI: 1215587126
Provider Name (Legal Business Name): HEALINGSPACES4U LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 NW DIVISION ST STE 101
GRESHAM OR
97030-5292
US

IV. Provider business mailing address

10350 N VANCOUVER WAY
PORTLAND OR
97217-7530
US

V. Phone/Fax

Practice location:
  • Phone: 503-688-3802
  • Fax: 888-887-8669
Mailing address:
  • Phone: 503-688-3802
  • Fax: 888-887-8669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SARITA EUGENIA TRAWICK
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 503-688-3802