Healthcare Provider Details

I. General information

NPI: 1386100501
Provider Name (Legal Business Name): THE HEALING HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 CHARMAN ST
OREGON CITY OR
97045-3018
US

IV. Provider business mailing address

604 CHARMAN ST
OREGON CITY OR
97045-3018
US

V. Phone/Fax

Practice location:
  • Phone: 503-877-8218
  • Fax: 503-389-7945
Mailing address:
  • Phone: 503-877-8218
  • Fax: 503-389-7945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GWEN SLAFF-WELCH
Title or Position: OWNER
Credential: LCSW
Phone: 503-877-8218