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General NPI Number Information
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NPI Number | 1396340550
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Entity Type | Organization
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Legal Business Name | BEYOND THE SELF, LLC
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 5305 RIVER RD N STE B
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City | KEIZER
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State | OR
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Zip | 97303-5324
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Country | US
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Telephone | 503-862-8238
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Fax |
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Provider Business Mailing Address
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Address Line | 304 NE MULTNOMAH ST APT 510
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City | PORTLAND
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State | OR
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Zip | 97232-3615
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Country | US
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Telephone | 503-862-8238
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANETA BUJNO
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Credential | LCSW, RN
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Telephone | 503-862-8238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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