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General NPI Number Information
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NPI Number | 1669830865
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Entity Type | Organization
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Legal Business Name | GATHERED & WISE LLC
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 112 E BURNETT ST
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City | STAYTON
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State | OR
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Zip | 97383-1704
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Country | US
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Telephone | 541-704-7511
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Fax | 541-325-4082
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Provider Business Mailing Address
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Address Line | 112 E BURNETT ST
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City | STAYTON
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State | OR
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Zip | 97383-1704
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Country | US
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Telephone | 541-704-7511
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Fax | 541-325-4082
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | MRS. HOLLY ELISE POMME
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Credential | LCSW, PMH-C
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Telephone | 541-704-7511
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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 | L6179
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License Number State | OR
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