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General NPI Number Information
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NPI Number | 1245035609
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Entity Type | Organization
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Legal Business Name | TURNING LEAF WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 1706 NE SHALE CT
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City | ROSEBURG
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State | OR
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Zip | 97470-5751
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Country | US
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Telephone | 559-978-0302
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 NE SHALE CT
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City | ROSEBURG
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State | OR
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Zip | 97470-5751
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Country | US
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Telephone | 559-978-0302
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | RONALD BUSTAMANTE
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Credential | CSWA
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Telephone | 559-978-0302
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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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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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