1295423366 NPI number — HUMMINGBIRD HEALING PSYCHOTHERAPY LLC

Table of content: SUZETTE LE VAN PERKINS (NPI 1689932857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295423366 NPI number — HUMMINGBIRD HEALING PSYCHOTHERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMMINGBIRD HEALING PSYCHOTHERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295423366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 TOUCHSTONE APT 70
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE OSWEGO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97035-1959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-248-4103
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 TOUCHSTONE APT 70
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE OSWEGO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97035-1959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-248-4103
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2023

Additional Information

Authorized Official

Authorized Official Last Name:
JAGLA
Authorized Official First Name:
PHILLIPA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
845-248-4103

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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