Healthcare Provider Details

I. General information

NPI: 1497489876
Provider Name (Legal Business Name): OPEN MINDS COUNSELING AND HYPNOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SE HIGHWAY 101 STE C
LINCOLN CITY OR
97367-2773
US

IV. Provider business mailing address

820 SE HIGHWAY 101 STE C
LINCOLN CITY OR
97367-2773
US

V. Phone/Fax

Practice location:
  • Phone: 971-227-8696
  • Fax:
Mailing address:
  • Phone: 971-227-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL DE LA TORRE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 206-745-6413