Provider Demographics
NPI:1851993554
Name:PEACEFUL WARRIOR WELLNESS SERVICES, LLC
Entity Type:Organization
Organization Name:PEACEFUL WARRIOR WELLNESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ BETTENCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:LPCA
Authorized Official - Phone:503-650-0680
Mailing Address - Street 1:11630 SE 40TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6195
Mailing Address - Country:US
Mailing Address - Phone:503-650-0680
Mailing Address - Fax:
Practice Address - Street 1:11630 SE 40TH AVE STE A
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6195
Practice Address - Country:US
Practice Address - Phone:503-650-0680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health