Provider Demographics
NPI:1730745886
Name:SPIRITUAL SELF INC.
Entity type:Organization
Organization Name:SPIRITUAL SELF INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SELF LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:971-241-0433
Mailing Address - Street 1:1272 SW EMMA DR
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-7642
Mailing Address - Country:US
Mailing Address - Phone:971-241-0433
Mailing Address - Fax:
Practice Address - Street 1:1300 NW ADAMS ST STE C
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3550
Practice Address - Country:US
Practice Address - Phone:503-883-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center