Provider Demographics
NPI:1295423366
Name:HUMMINGBIRD HEALING PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:HUMMINGBIRD HEALING PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIPA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-248-4103
Mailing Address - Street 1:4 TOUCHSTONE APT 70
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1959
Mailing Address - Country:US
Mailing Address - Phone:845-248-4103
Mailing Address - Fax:
Practice Address - Street 1:4 TOUCHSTONE APT 70
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1959
Practice Address - Country:US
Practice Address - Phone:845-248-4103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)