Healthcare Provider Details

I. General information

NPI: 1568387173
Provider Name (Legal Business Name): EARTH SPIRIT SOMATICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3157 SW QUARTZ AVE
REDMOND OR
97756-7853
US

IV. Provider business mailing address

3157 SW QUARTZ AVE
REDMOND OR
97756-7853
US

V. Phone/Fax

Practice location:
  • Phone: 503-477-0775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DENISE KIMBALL
Title or Position: OWNER
Credential: LPC
Phone: 503-477-0775