Provider Demographics
NPI:1023624780
Name:FLOURISH COUNSELING AND WELLNESS CENTER
Entity type:Organization
Organization Name:FLOURISH COUNSELING AND WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:503-998-3584
Mailing Address - Street 1:8401 NE HALSEY ST STE 107
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-5670
Mailing Address - Country:US
Mailing Address - Phone:503-998-3584
Mailing Address - Fax:503-974-2432
Practice Address - Street 1:8401 NE HALSEY ST STE 107
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5670
Practice Address - Country:US
Practice Address - Phone:971-401-7119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty