| Eternal Blossom Counseling Llc | |
|
4531 Se Belmont St Ste 310 Portland OR 97215-1675 | |
| (503) 810-1170 | |
| Not Available |
| Full Name | Eternal Blossom Counseling Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 4531 Se Belmont St Ste 310, Portland, Oregon |
| Authorized Official Name and Position | Aiyana Lucas (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 9713616747 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eternal Blossom Counseling Llc 3335 Se 69th Ave Portland OR 97206-2613 Ph: (503) 810-1170 | Eternal Blossom Counseling Llc 4531 Se Belmont St Ste 310 Portland OR 97215-1675 Ph: (503) 810-1170 |
| NPI Number | 1104389170 |
|---|---|
| Provider Enumeration Date | 04/08/2019 |
| Last Update Date | 04/08/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104389170 | NPI | - | NPPES |
| 500731868 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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