| Awakened Heart Pdx, Llc | |
|
1306 Nw Hoyt St Ste 407 Portland OR 97209-2787 | |
| (971) 407-3930 | |
| Not Available |
| Full Name | Awakened Heart Pdx, Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 1306 Nw Hoyt St Ste 407, Portland, Oregon |
| Authorized Official Name and Position | Ann Marie Mchenry (OWNER, MARRIAGE & FAMILY THERAPIST) |
| Authorized Official Contact | 9714073930 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Awakened Heart Pdx, Llc 1306 Nw Hoyt St Ste 407 Portland OR 97209-2787 Ph: (971) 407-3930 | Awakened Heart Pdx, Llc 1306 Nw Hoyt St Ste 407 Portland OR 97209-2787 Ph: (971) 407-3930 |
| NPI Number | 1467979914 |
|---|---|
| Provider Enumeration Date | 08/25/2017 |
| Last Update Date | 03/11/2022 |
| Certification Date | 03/11/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467979914 | NPI | - | NPPES |
| 1477854750 | Other | NPI TYPE 1 | |
| 1609295682 | Other | NPI | |
| 1134628571 | Other | OR | NPI TYPE 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | T1051 (Oregon) | Primary |
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