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General NPI Number Information
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NPI Number | 1609731835
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Entity Type | Organization
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Legal Business Name | IMAGINATIVE HEALING COLLECTIVE
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Dates
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Enumeration Date | 12/19/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 28925 SW BOBERG RD
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City | WILSONVILLE
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State | OR
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Zip | 97070-8218
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Country | US
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Telephone | 503-939-9447
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Fax |
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Provider Business Mailing Address
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Address Line | 29385 SW TETON WAY
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City | WILSONVILLE
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State | OR
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Zip | 97070-8501
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Country | US
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Telephone | 503-939-9447
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | CARMEN RYAN
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Credential | LPC, MS, MBA
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Telephone | 503-939-9447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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