Healthcare Provider Details

I. General information

NPI: 1346157708
Provider Name (Legal Business Name): FULL BLOOM THERAPY PDX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 WILLAMETTE FALLS DR STE 105
WEST LINN OR
97068-4353
US

IV. Provider business mailing address

8323 SE 69TH AVE
PORTLAND OR
97206-8731
US

V. Phone/Fax

Practice location:
  • Phone: 503-272-1167
  • Fax:
Mailing address:
  • Phone: 503-272-1167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: LAUREN BARTHELEMY
Title or Position: OWNER
Credential: LPC
Phone: 503-272-1167