Provider Demographics
NPI:1225387996
Name:ELIAHIM, MISAO (LMFT ASSOCIATE/QMHP)
Entity Type:Individual
Prefix:
First Name:MISAO
Middle Name:
Last Name:ELIAHIM
Suffix:
Gender:F
Credentials:LMFT ASSOCIATE/QMHP
Other - Prefix:
Other - First Name:MISAO
Other - Middle Name:
Other - Last Name:MICHIKAMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MILES
Mailing Address - Street 1:2951 NW DIVISION ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5294
Mailing Address - Country:US
Mailing Address - Phone:503-988-7480
Mailing Address - Fax:
Practice Address - Street 1:8420 N IVANHOE ST #83811
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203
Practice Address - Country:US
Practice Address - Phone:503-482-2400
Practice Address - Fax:503-689-8481
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist