Healthcare Provider Details

I. General information

NPI: 1023624780
Provider Name (Legal Business Name): FLOURISH COUNSELING AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 NE HALSEY ST STE 107
PORTLAND OR
97220-5670
US

IV. Provider business mailing address

8401 NE HALSEY ST STE 107
PORTLAND OR
97220-5670
US

V. Phone/Fax

Practice location:
  • Phone: 971-401-7119
  • Fax:
Mailing address:
  • Phone: 503-998-3584
  • Fax: 503-974-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. RACHAEL ALEXIS JACKSON
Title or Position: THERAPIST/OWNER
Credential: MSW, LCSW
Phone: 503-998-3584