MEDICARE: HEAD & HEART THERAPY, LLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1710565692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAD & HEART THERAPY, LLC

Provider Business Mailing Address
First Line	:	917 SW OAK ST STE 303
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2806
Country	:	US
Telephone Number	:	971-200-0482
Fax Number	:	844-479-2683

Provider Business Practice Location Address
First Line	:	917 SW OAK ST STE 303
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2806
Country	:	US
Telephone Number	:	971-200-0482
Fax Number	:	844-479-2683

Authorized Official
Title or Position	:	THERAPIST
Name	:	SARAH SAINT JOHN DOBEY
Credential	:	LPC
Telephone Number	:	971-200-0482

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	11/03/2021

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