Provider Demographics
NPI:1760350540
Name:WELLBEING TRAILHEAD LLC
Entity type:Organization
Organization Name:WELLBEING TRAILHEAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR/PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WILT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT, LPC, NCC
Authorized Official - Phone:971-242-9322
Mailing Address - Street 1:212 NE 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-7016
Mailing Address - Country:US
Mailing Address - Phone:971-888-2785
Mailing Address - Fax:
Practice Address - Street 1:212 NE 80TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-7016
Practice Address - Country:US
Practice Address - Phone:971-888-2785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-24
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty