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General NPI Number Information
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NPI Number | 1245966613
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Entity Type | Organization
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Legal Business Name | LIVING TREE WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 2855 E HAYES ST STE 205
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City | NEWBERG
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State | OR
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Zip | 97132-1390
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Country | US
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Telephone | 503-431-0063
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Fax | 503-554-1848
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Provider Business Mailing Address
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Address Line | 901 BRUTSCHER ST STE D PMB 150
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City | NEWBERG
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State | OR
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Zip | 97132
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Country | US
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Telephone | 503-431-0063
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Fax | 503-554-1848
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Authorized Official
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Title or Position | OWNER
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Name | MARLENA LAURA-JOANN JOHNSON
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Credential | LCSW
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Telephone | 503-431-0063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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