Provider Demographics
NPI:1457934283
Name:SOMATIC TRAUMA HEALING NW LLC
Entity Type:Organization
Organization Name:SOMATIC TRAUMA HEALING NW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-939-8061
Mailing Address - Street 1:10117 SE SUNNYSIDE RD STE F1252
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7708
Mailing Address - Country:US
Mailing Address - Phone:503-939-8061
Mailing Address - Fax:
Practice Address - Street 1:27275 SE SUTTLE RD
Practice Address - Street 2:
Practice Address - City:EAGLE CREEK
Practice Address - State:OR
Practice Address - Zip Code:97022-9795
Practice Address - Country:US
Practice Address - Phone:503-939-8061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty