Provider Demographics
NPI:1376955641
Name:OAK SPRINGS WELLNESS CENTRE, LLC
Entity Type:Organization
Organization Name:OAK SPRINGS WELLNESS CENTRE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRUTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, ACS
Authorized Official - Phone:503-910-5880
Mailing Address - Street 1:4505 EAGLE CREST RD NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-9729
Mailing Address - Country:US
Mailing Address - Phone:503-983-1559
Mailing Address - Fax:
Practice Address - Street 1:131 PINE ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0728
Practice Address - Country:US
Practice Address - Phone:503-983-1559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2439251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health