Provider Demographics
NPI:1669281838
Name:KINTSUGI ACUPUNCTURE AND PSYCHIATRIC CARE
Entity type:Organization
Organization Name:KINTSUGI ACUPUNCTURE AND PSYCHIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-551-0988
Mailing Address - Street 1:1535 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4255
Mailing Address - Country:US
Mailing Address - Phone:971-720-1639
Mailing Address - Fax:
Practice Address - Street 1:1535 STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4255
Practice Address - Country:US
Practice Address - Phone:971-720-1639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty