Healthcare Provider Details

I. General information

NPI: 1518446665
Provider Name (Legal Business Name): HEART STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 CENTER DR # B-189
MEDFORD OR
97501-7908
US

IV. Provider business mailing address

PO BOX 1787
MEDFORD OR
97501-0261
US

V. Phone/Fax

Practice location:
  • Phone: 530-228-5212
  • Fax: 458-203-5051
Mailing address:
  • Phone: 888-556-7282
  • Fax: 458-203-5051

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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH LYNNE DEVINE
Title or Position: PRINCIPAL/MANAGER
Credential: LMFT
Phone: 530-228-5212