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General NPI Number Information
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NPI Number | 1194404020
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Entity Type | Organization
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Legal Business Name | BLUE MOUNTAIN HEALING, LLC
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 5741 NE GLISAN ST STE 2
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City | PORTLAND
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State | OR
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Zip | 97213-3793
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Country | US
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Telephone | 503-663-8402
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 554
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City | FAIRVIEW
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State | OR
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Zip | 97024-0554
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Country | US
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Telephone | 503-663-8402
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENETTE ARELLANO
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Credential |
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Telephone | 503-663-8402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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