Provider Demographics
NPI:1568851335
Name:YOUR HEALING PATH, LLC
Entity type:Organization
Organization Name:YOUR HEALING PATH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KSENIYA
Authorized Official - Middle Name:STEVENS
Authorized Official - Last Name:LAC
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:541-480-4970
Mailing Address - Street 1:2660 NE HIGHWAY 20
Mailing Address - Street 2:#610-450
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2275 NE DOCTORS DR STE 11B
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6324
Practice Address - Country:US
Practice Address - Phone:541-480-4970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01017171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1427105345OtherNPI