Organization
PERFECTLY BROKEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL LARA CADC I, CRM (ADDICTION COUNSELOR/CO-OWNER)
(541) 429-0313
Entity
Organization
Contact information
Practice address
256 E HURLBURT AVE STE 117, HERMISTON, OR 97838-2443
(541) 429-0313
Mailing address
PO BOX 253, UMATILLA, OR 97882-0253
(541) 429-0313
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
02/13/2024
Last updated
02/13/2024
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