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General NPI Number Information
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NPI Number | 1669281838
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Entity Type | Organization
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Legal Business Name | KINTSUGI ACUPUNCTURE AND PSYCHIATRIC CARE
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 1535 STATE ST
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City | SALEM
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State | OR
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Zip | 97301-4255
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Country | US
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Telephone | 971-720-1639
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Fax |
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Provider Business Mailing Address
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Address Line | 1535 STATE ST
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City | SALEM
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State | OR
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Zip | 97301-4255
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Country | US
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Telephone | 971-720-1639
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. BRYON LEVERMAN
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Credential | LAC
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Telephone | 503-551-0988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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