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General NPI Number Information
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NPI Number | 1053186247
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Entity Type | Organization
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Legal Business Name | ILLUMINATE HEALING LLC
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 2926 NE FLANDERS ST STE 3A
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City | PORTLAND
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State | OR
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Zip | 97232-3259
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Country | US
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Telephone | 503-272-1482
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Fax |
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Provider Business Mailing Address
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Address Line | 3439 SE HAWTHORNE BLVD # 1177
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City | PORTLAND
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State | OR
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Zip | 97214-5048
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Country | US
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Telephone | 503-272-1482
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Fax | 503-427-9765
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | LINNEA STENHOUSE
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Credential | LCSW
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Telephone | 503-272-1482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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