| Wild Oak Therapeutic Farm, Llc | |
|
29691 Sw Riverwood Dr West Linn OR 97068-9440 | |
| (503) 880-2676 | |
| Not Available |
| Full Name | Wild Oak Therapeutic Farm, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 29691 Sw Riverwood Dr, West Linn, Oregon |
| Authorized Official Name and Position | Nicole Byers (OWNER) |
| Authorized Official Contact | 5038802676 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Oak Therapeutic Farm, Llc 29691 Sw Riverwood Dr West Linn OR 97068-9440 Ph: (503) 880-2676 | Wild Oak Therapeutic Farm, Llc 29691 Sw Riverwood Dr West Linn OR 97068-9440 Ph: (503) 880-2676 |
| NPI Number | 1750190781 |
|---|---|
| Provider Enumeration Date | 01/03/2025 |
| Last Update Date | 01/09/2025 |
| Certification Date | 01/09/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750190781 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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