NPIMap

Organization Active NPI

Tigard Holistic Health Clinic, LLC

  • Clinic/Center
  • Tigard, OR
National Provider Identifier
1053670117
Registry record updated May 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
0855 Issued in OR
Legal business name
TIGARD HOLISTIC HEALTH CLINIC, LLC
Practice address
11930 SW Greenburg Rd
Tigard, OR 97223-6453
Phone
(503) 639-1712
NPI assigned
May 10, 2012
Last updated
May 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Stacey Lynn Raffety, NDNPI 1003861493
Title
Owner
Phone
(503) 639-1712

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 0855 OR Primary

Addresses

Primary practice location

11930 SW Greenburg Rd
Tigard, OR 97223-6453

Mailing address

11930 SW Greenburg Rd
Tigard, OR 97223-6453
Phone (503) 639-1712

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336608000000",
    "number": "1053670117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11930 SW GREENBURG RD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236453",
            "telephone_number": "503-639-1712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11930 SW GREENBURG RD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236453",
            "telephone_number": "503-639-1712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIGARD HOLISTIC HEALTH CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-10",
        "last_updated": "2012-05-10",
        "status": "A",
        "authorized_official_last_name": "RAFFETY",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-639-1712",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ND"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "0855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.