Provider Demographics
NPI:1437579703
Name:PORTLAND HEARTMIND COUNSELING
Entity Type:Organization
Organization Name:PORTLAND HEARTMIND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKANOUE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:503-481-2142
Mailing Address - Street 1:4950 NW 140TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-2402
Mailing Address - Country:US
Mailing Address - Phone:503-481-2142
Mailing Address - Fax:
Practice Address - Street 1:4950 NW 140TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-2402
Practice Address - Country:US
Practice Address - Phone:503-481-2142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3403251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health