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General NPI Number Information
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NPI Number | 1275205379
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Entity Type | Organization
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Legal Business Name | BEAN BAG THERAPY
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 25 6TH ST
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City | FAIRVIEW
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State | OR
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Zip | 97024-1941
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Country | US
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Telephone | 818-579-2029
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Fax |
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Provider Business Mailing Address
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Address Line | 25 6TH ST
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City | FAIRVIEW
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State | OR
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Zip | 97024-1941
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Country | US
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Telephone | 818-579-2029
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR/ONLY MEMBER
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Name | MRS. LISA PEACOCK MCLAUGHLIN
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Credential | LMFT
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Telephone | 818-579-2029
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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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