| Sprout Therapy Pdx Llc | |
|
7704 N Hereford Ave Portland OR 97203-3434 | |
| (971) 319-4827 | |
| (503) 662-6220 |
| Full Name | Sprout Therapy Pdx Llc |
|---|---|
| Speciality | Counselor |
| Location | 7704 N Hereford Ave, Portland, Oregon |
| Authorized Official Name and Position | Emelie Angelina Blank (OWNER & LEAD CLINICAN) |
| Authorized Official Contact | 9713194827 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sprout Therapy Pdx Llc 6012 N Villard Ave Portland OR 97217-4039 Ph: (206) 890-8045 | Sprout Therapy Pdx Llc 7704 N Hereford Ave Portland OR 97203-3434 Ph: (971) 319-4827 |
| NPI Number | 1093346777 |
|---|---|
| Provider Enumeration Date | 01/30/2020 |
| Last Update Date | 01/30/2020 |
| Certification Date | 01/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093346777 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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