| Perfectly Broken Llc | |
|
256 E Hurlburt Ave Ste 117 Hermiston OR 97838-2443 | |
| (541) 429-0313 | |
| Not Available |
| Full Name | Perfectly Broken Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 256 E Hurlburt Ave Ste 117, Hermiston, Oregon |
| Authorized Official Name and Position | Crystal Lara (ADDICTION COUNSELOR/CO-OWNER) |
| Authorized Official Contact | 5414290313 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Perfectly Broken Llc Po Box 253 Umatilla OR 97882-0253 Ph: (541) 429-0313 | Perfectly Broken Llc 256 E Hurlburt Ave Ste 117 Hermiston OR 97838-2443 Ph: (541) 429-0313 |
| NPI Number | 1821852526 |
|---|---|
| Provider Enumeration Date | 02/13/2024 |
| Last Update Date | 02/13/2024 |
| Certification Date | 02/12/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821852526 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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