Provider Demographics
NPI:1275157232
Name:BUENAVIDA THERAPY LLC
Entity Type:Organization
Organization Name:BUENAVIDA THERAPY LLC
Other - Org Name:BUENAVIDA THERAPY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:ROCIO
Authorized Official - Last Name:SOLARES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-330-0511
Mailing Address - Street 1:576 SE CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4429
Mailing Address - Country:US
Mailing Address - Phone:503-330-0511
Mailing Address - Fax:
Practice Address - Street 1:535 SE WASHINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4142
Practice Address - Country:US
Practice Address - Phone:503-330-0511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)