Healthcare Provider Details

I. General information

NPI: 1457404410
Provider Name (Legal Business Name): INNER JOURNEY HEALING ARTS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 W MAIN ST
HILLSBORO OR
97123-3962
US

IV. Provider business mailing address

28932 HUBER RD
SCAPPOOSE OR
97056-2027
US

V. Phone/Fax

Practice location:
  • Phone: 503-621-8735
  • Fax: 503-543-6101
Mailing address:
  • Phone: 503-543-6100
  • Fax: 503-543-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number02-R-13
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number63212
License Number StateOR

VIII. Authorized Official

Name: MISS LISA ANN BURNELL
Title or Position: PROGRAM DIRECTOR
Credential: M.ED,CADCII,CHT
Phone: 503-621-8735