Provider Demographics
NPI:1215635396
Name:MESMERIZED GALLERY AND HEALING SPACE
Entity type:Organization
Organization Name:MESMERIZED GALLERY AND HEALING SPACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC ASSOCIATE
Authorized Official - Phone:503-523-9569
Mailing Address - Street 1:1767 12TH ST # 262
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-9531
Mailing Address - Country:US
Mailing Address - Phone:503-523-9569
Mailing Address - Fax:
Practice Address - Street 1:363 E JEWETT BLVD # 1
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-3001
Practice Address - Country:US
Practice Address - Phone:503-523-9569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty