MANDALA MENTAL AND BEHAVIORAL HEALTH LLC NPI 1104333103

NPI Information

NPI: 1104333103
Provider Name: MANDALA MENTAL AND BEHAVIORAL HEALTH, LLC
Classification: Counselor - 101YP2500X
Entity Type: Organization

Specialization: Professional

Address:
650 NE HOLLADAY ST STE 16001614
PORTLAND, OR
ZIP 97232
Phone: (503) 367-3630
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MANDALA MENTAL AND BEHAVIORAL HEALTH, LLC is a professional counselor in Portland, OR. MANDALA MENTAL AND BEHAVIORAL HEALTH, LLC NPI is 1104333103. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

650 NE HOLLADAY ST STE 16001614
PORTLAND, OR
ZIP 97232-045
Phone: (503) 367-3630
Fax: (503) 224-3126

The provider's authorized official is Daniel J Gilbride .
The authorized official title is Director and has the following contact phone number (503) 367-3630.

The enumeration date for this NPI number is 12/29/2017 and was last updated on 6/16/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1041C0700X	Social Worker	Clinical		OREGON	No
2	251S00000X	Community/Behavioral Health		C4036	OREGON	No
3	101YP2500X	Counselor	Professional	C4036	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	13804154	OTHER		NATIONAL PROVIDER NUMBER, TERESA CONLAN
2	1942662150	OTHER		NATIONAL PROVIDER NUMBER, DANIEL GILBRIDE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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