Organization
WISHING WELLNESS COUNSELING AND COACHING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE GALLIAN LCSW (OWNER/OPERATOR)
(503) 803-9323
Entity
Organization
Contact information
Practice address
406 NE 4TH ST STE 114, GRESHAM, OR 97030-7496
(503) 803-9323
(503) 674-9740
Mailing address
406 NE 4TH ST STE 114, GRESHAM, OR 97030-7496
(503) 803-9323
(503) 674-9740
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1779833311
NPI TYPE 1
OR
Enumeration date
03/11/2021
Last updated
03/11/2021
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