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General NPI Number Information
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NPI Number | 1215635396
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Entity Type | Organization
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Legal Business Name | MESMERIZED GALLERY AND HEALING SPACE
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 363 E JEWETT BLVD # 1
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City | WHITE SALMON
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State | WA
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Zip | 98672-3001
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Country | US
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Telephone | 503-523-9569
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Fax |
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Provider Business Mailing Address
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Address Line | 1767 12TH ST # 262
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City | HOOD RIVER
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State | OR
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Zip | 97031-9531
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Country | US
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Telephone | 503-523-9569
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JILLIAN MARIE BROWN
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Credential | LPC ASSOCIATE
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Telephone | 503-523-9569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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