Provider Demographics
NPI:1316216229
Name:WELL WITHIN, LLC
Entity Type:Organization
Organization Name:WELL WITHIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MACOM
Authorized Official - Phone:503-734-7508
Mailing Address - Street 1:541 SE PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-7823
Mailing Address - Country:US
Mailing Address - Phone:503-734-7508
Mailing Address - Fax:503-664-4164
Practice Address - Street 1:709 NE 5TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:503-734-7508
Practice Address - Fax:503-664-4164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC156402171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500698682Medicaid