Provider Demographics
NPI:1447742481
Name:THE HEALING ALLIANCE LLC
Entity Type:Organization
Organization Name:THE HEALING ALLIANCE LLC
Other - Org Name:JENNIFER BERGMANS YBARRA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BERGMANS
Authorized Official - Last Name:YBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MSW
Authorized Official - Phone:503-481-3512
Mailing Address - Street 1:9620 NE TANASBOURNE DR STE 300-75
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7843
Mailing Address - Country:US
Mailing Address - Phone:503-481-3512
Mailing Address - Fax:866-472-4531
Practice Address - Street 1:9620 NE TANASBOURNE DR STE 300-75
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7843
Practice Address - Country:US
Practice Address - Phone:503-481-3512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEALING ALLIANCE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-05
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL75991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500740982Medicaid