Organization
BRAINBOW FORGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIENA JOY LCSW, L10767, CLSS (THERAPIST)
(541) 229-7879
Entity
Organization
Contact information
Practice address
137 HALL AVE, COOS BAY, OR 97420-1519
(541) 229-7879
Mailing address
3367 W 18TH AVE, EUGENE, OR 97402-3109
(541) 229-7879
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
07/18/2024
Last updated
05/20/2025
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