| Mindful Therapy Pdx Pc | |
|
423 Ne 60th Ave Portland OR 97213-3725 | |
| (503) 734-0552 | |
| Not Available |
| Full Name | Mindful Therapy Pdx Pc |
|---|---|
| Speciality | Counselor |
| Location | 423 Ne 60th Ave, Portland, Oregon |
| Authorized Official Name and Position | Ronald L Johnson (PRESIDENT) |
| Authorized Official Contact | 5037340552 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Therapy Pdx Pc 636 N Lombard St Portland OR 97217-1576 Ph: (503) 734-0552 | Mindful Therapy Pdx Pc 423 Ne 60th Ave Portland OR 97213-3725 Ph: (503) 734-0552 |
| NPI Number | 1134991524 |
|---|---|
| Provider Enumeration Date | 10/27/2023 |
| Last Update Date | 11/06/2023 |
| Certification Date | 11/06/2023 |
| Medicare PECOS PAC ID | 6204373798 |
|---|---|
| Medicare Enrollment ID | O20240801002722 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134991524 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Ronald Lee Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114460656 PECOS PAC ID: 9931646437 Enrollment ID: I20240801002787 |
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