| Flourish Authentically Llc | |
|
833 Se Main St # 213 Portland OR 97214-3454 | |
| (510) 626-0215 | |
| Not Available |
| Full Name | Flourish Authentically Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 833 Se Main St # 213, Portland, Oregon |
| Authorized Official Name and Position | Lily S Krutel (OWNER AND PSYCHOTHERAPIST) |
| Authorized Official Contact | 5106260215 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Flourish Authentically Llc 833 Se Main St. Box 302 Portland OR 97214 Ph: (510) 626-0215 | Flourish Authentically Llc 833 Se Main St # 213 Portland OR 97214-3454 Ph: (510) 626-0215 |
| NPI Number | 1588411060 |
|---|---|
| Provider Enumeration Date | 05/02/2024 |
| Last Update Date | 10/23/2024 |
| Certification Date | 10/23/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588411060 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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