Healthcare Provider Details

I. General information

NPI: 1003411273
Provider Name (Legal Business Name): CULTURED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6745 SW HAMPTON ST STE 200
TIGARD OR
97223-8360
US

IV. Provider business mailing address

6745 SW HAMPTON ST STE 200
TIGARD OR
97223-8360
US

V. Phone/Fax

Practice location:
  • Phone: 877-301-9077
  • Fax: 866-959-3177
Mailing address:
  • Phone: 877-301-9077
  • Fax: 866-959-3177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. STEFFANNIE ROACHE
Title or Position: OWNER/OPERATOR
Credential: MS, LPC
Phone: 971-717-2307