Provider Demographics
NPI:1073241030
Name:INNER ROOM SOMATIC THERAPY, LLC
Entity Type:Organization
Organization Name:INNER ROOM SOMATIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BREHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-275-6349
Mailing Address - Street 1:887 E 39TH PL
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4539
Mailing Address - Country:US
Mailing Address - Phone:541-275-6349
Mailing Address - Fax:541-516-7085
Practice Address - Street 1:840 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2828
Practice Address - Country:US
Practice Address - Phone:541-275-6349
Practice Address - Fax:541-516-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty