Provider Demographics
NPI:1851724124
Name:MULBERRY HEALING ARTS, LLC
Entity Type:Organization
Organization Name:MULBERRY HEALING ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FUMIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:508-680-0835
Mailing Address - Street 1:5203 NE 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6917
Mailing Address - Country:US
Mailing Address - Phone:503-680-0835
Mailing Address - Fax:
Practice Address - Street 1:3808 N WILLIAMS AVE
Practice Address - Street 2:SUITE F
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1467
Practice Address - Country:US
Practice Address - Phone:503-680-0835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC#160515171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty