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General NPI Number Information
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NPI Number | 1235790304
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Entity Type | Organization
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Legal Business Name | SANGSUREE WELLNESS
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 5510 N COMMERCIAL AVE
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City | PORTLAND
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State | OR
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Zip | 97217-2340
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Country | US
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Telephone | 503-332-7003
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Fax |
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Provider Business Mailing Address
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Address Line | 4207 SE WOODSTOCK BLVD PO BOX 298
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City | PORTLAND
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State | OR
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Zip | 97206-6267
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Country | US
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Telephone | 503-332-7003
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MICHAELA DAVIS
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Credential |
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Telephone | 503-901-9508
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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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