Organization
LIVING TREE WELLNESS CENTER, LLC
Active
Other names
Living Tree Wellness Center LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MARLENA LAURA-JOANN JOHNSON LCSW (OWNER)
(503) 431-0063
Entity
Organization
Contact information
Practice address
2855 E HAYES ST STE 205, NEWBERG, OR 97132-1390
(503) 431-0063
(503) 554-1848
Mailing address
901 BRUTSCHER ST STE D PMB 150, NEWBERG, OR 97132
(503) 431-0063
(503) 554-1848
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437409414
—
OR
Enumeration date
07/28/2022
Last updated
07/28/2022
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