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General NPI Number Information
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NPI Number | 1730745886
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Entity Type | Organization
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Legal Business Name | SPIRITUAL SELF INC.
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 1300 NW ADAMS ST STE C
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City | MCMINNVILLE
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State | OR
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Zip | 97128-3550
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Country | US
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Telephone | 503-883-0099
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Fax |
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Provider Business Mailing Address
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Address Line | 1272 SW EMMA DR
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City | MCMINNVILLE
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State | OR
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Zip | 97128-7642
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Country | US
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Telephone | 971-241-0433
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANGELA D SELF LINDSEY
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Credential | LMT
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Telephone | 971-241-0433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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