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General NPI Number Information
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NPI Number | 1205735024
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Entity Type | Organization
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Legal Business Name | WELLNESS THERAPY INC
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Dates
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Enumeration Date | 11/05/2026
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Last Update Date | 11/05/2026
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Provider Practice Location Address
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Address Line | 14738 SW 78TH AVE 14738 SW 78TH AVE
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City | TIGARD
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State | OR
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Zip | 97224-0005
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Country | US
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Telephone | 503-705-3043
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Fax | 971-708-6113
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Provider Business Mailing Address
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Address Line | 14738 SW 78TH AVE 14738 SW 78TH AVE
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City | TIGARD
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State | OR
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Zip | 97224-0005
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Country | US
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Telephone | 503-705-3043
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Fax | 971-708-6113
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANNIE PETROSSIAN
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Credential | LPC
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Telephone | 503-300-8883
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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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