| Living Tree Wellness Center, Llc | |
|
2855 E Hayes St Ste 205 Newberg OR 97132-1390 | |
| (503) 431-0063 | |
| (503) 554-1848 |
| Full Name | Living Tree Wellness Center, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2855 E Hayes St Ste 205, Newberg, Oregon |
| Authorized Official Name and Position | Marlena Laura-joann Johnson (OWNER) |
| Authorized Official Contact | 5034310063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Tree Wellness Center, Llc 901 Brutscher St Ste D Pmb 150 Newberg OR 97132 Ph: (503) 431-0063 | Living Tree Wellness Center, Llc 2855 E Hayes St Ste 205 Newberg OR 97132-1390 Ph: (503) 431-0063 |
| NPI Number | 1245966613 |
|---|---|
| Provider Enumeration Date | 07/28/2022 |
| Last Update Date | 07/28/2022 |
| Certification Date | 07/28/2022 |
| Medicare PECOS PAC ID | 7618346073 |
|---|---|
| Medicare Enrollment ID | O20221207002415 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245966613 | NPI | - | NPPES |
| 1437409414 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Marlena Laura-joann Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437409414 PECOS PAC ID: 5496124752 Enrollment ID: I20221207003082 |
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