MEDICARE: OPEN MINDS COUNSELING AND HYPNOTHERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497489876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MINDS COUNSELING AND HYPNOTHERAPY

Provider Business Mailing Address
First Line	:	820 SE HIGHWAY 101 STE C
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-2773
Country	:	US
Telephone Number	:	971-227-8696
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 SE HIGHWAY 101 STE C
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-2773
Country	:	US
Telephone Number	:	971-227-8696
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	CRYSTAL DE LA TORRE
Credential	:
Telephone Number	:	206-745-6413

Provider Enumeration Date	:	07/12/2022
Last Update Date	:	05/08/2026

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