Provider Demographics
NPI:1184012585
Name:HEALING TREE FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:HEALING TREE FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:OTTERSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:541-688-1569
Mailing Address - Street 1:1000 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3230
Mailing Address - Country:US
Mailing Address - Phone:541-688-1569
Mailing Address - Fax:541-461-6884
Practice Address - Street 1:1000 RIVER RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-3230
Practice Address - Country:US
Practice Address - Phone:541-688-1569
Practice Address - Fax:541-461-6884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1162175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty