Provider Demographics
NPI:1235653379
Name:MIRSEPASSI, MEREDITH MARIE (LPC, CADCI)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:MARIE
Last Name:MIRSEPASSI
Suffix:
Gender:F
Credentials:LPC, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 NE 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3442
Mailing Address - Country:US
Mailing Address - Phone:503-544-7962
Mailing Address - Fax:
Practice Address - Street 1:8855 SW HOLLY LN STE 105
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8792
Practice Address - Country:US
Practice Address - Phone:503-544-7962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health