Provider Demographics
NPI:1033974944
Name:VIBRANT MENTAL WELLNESS LLC
Entity Type:Organization
Organization Name:VIBRANT MENTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-267-8216
Mailing Address - Street 1:10260 SW GREENBURG RD FL 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10260 SW GREENBURG RD FL 4
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5500
Practice Address - Country:US
Practice Address - Phone:763-568-6378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIBRANT MENTAL WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty