Healthcare Provider Details

I. General information

NPI: 1245966613
Provider Name (Legal Business Name): LIVING TREE WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 E HAYES ST STE 205
NEWBERG OR
97132-1390
US

IV. Provider business mailing address

901 BRUTSCHER ST STE D PMB 150
NEWBERG OR
97132
US

V. Phone/Fax

Practice location:
  • Phone: 503-431-0063
  • Fax: 503-554-1848
Mailing address:
  • Phone: 503-567-2894
  • Fax: 503-388-3581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARLENA LAURA-JOANN JOHNSON
Title or Position: OWNER/CLINICIAN
Credential: LCSW
Phone: 503-567-2894