Healthcare Provider Details

I. General information

NPI: 1467232256
Provider Name (Legal Business Name): TERRAIN WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 SW WESTGATE DR STE 320
PORTLAND OR
97221-2447
US

IV. Provider business mailing address

5440 SW WESTGATE DR STE 320
PORTLAND OR
97221-2447
US

V. Phone/Fax

Practice location:
  • Phone: 503-847-9211
  • Fax: 503-549-8971
Mailing address:
  • Phone: 503-847-9211
  • Fax: 503-549-8971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIELLE S LOCKWOOD
Title or Position: OWNER
Credential: ND
Phone: 213-509-0764