| Wild Open Being, Llc | |
|
7831 Se Stark St Ste 211 Portland OR 97215-2313 | |
| (714) 609-0015 | |
| Not Available |
| Full Name | Wild Open Being, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 7831 Se Stark St Ste 211, Portland, Oregon |
| Authorized Official Name and Position | Simone Levine (OWNER) |
| Authorized Official Contact | 7146090015 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Open Being, Llc 1512 Ne Holman St Portland OR 97211-4850 Ph: (714) 609-0015 | Wild Open Being, Llc 7831 Se Stark St Ste 211 Portland OR 97215-2313 Ph: (714) 609-0015 |
| NPI Number | 1265288542 |
|---|---|
| Provider Enumeration Date | 04/26/2024 |
| Last Update Date | 04/26/2024 |
| Certification Date | 04/26/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265288542 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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