Organization · Type 2 NPI
Mandala Mental and Behavioral Health, LLC
Professional Counselor · Portland, OR
NPI number
1104333103
Active
Practice location
650 NE Holladay St Ste 16001614
Portland, OR 97232-2045
Fax (503) 224-3126
Mailing address
650 NE Holladay St Ste 1600
Portland, OR 97232-2035
Other practice locations
- 511 SW 10th Ave Ste 601, Portland, OR 97205-2707 · (503) 367-3630
- 650 NE Holladay St Ste 16001614, Portland, OR 97232-2045 · (503) 367-3630
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Professional Counselor Primary | 101YP2500X | C4036 (OR) |
| Clinical Social Worker | 1041C0700X | None listed |
| Community/Behavioral Health Agency | 251S00000X | C4036 (OR) |
Professional Counselor: Definition to come...
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About NPI 1104333103
Mandala Mental and Behavioral Health, LLC's National Provider Identifier is 1104333103, issued on Dec 29, 2017. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Portland, OR. The record was last updated on Jun 16, 2018.