Provider Demographics
NPI:1265281000
Name:I AM WELL THERAPY PC
Entity type:Organization
Organization Name:I AM WELL THERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FALK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-285-4950
Mailing Address - Street 1:1110 SE ALDER ST. STE 301
Mailing Address - Street 2:MB #122
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2400
Mailing Address - Country:US
Mailing Address - Phone:909-285-4950
Mailing Address - Fax:909-285-0564
Practice Address - Street 1:1110 SE ALDER ST. STE 301
Practice Address - Street 2:MB #122
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2400
Practice Address - Country:US
Practice Address - Phone:909-285-4950
Practice Address - Fax:909-285-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty