# BRAINBOW FORGE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659119030
- **Authorized official:** MARIENA JOY LCSW, L10767, CLSS (THERAPIST)
- **Authorized official phone:** (541) 229-7879

## Contact information

- **Practice address:** 137 HALL AVE, COOS BAY, OR 97420-1519
- **Practice address phone:** (541) 229-7879
- **Mailing address:** 3367 W 18TH AVE, EUGENE, OR 97402-3109
- **Mailing address phone:** (541) 229-7879

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 07/18/2024
- **Last updated:** 05/20/2025