Provider Demographics
NPI:1588017065
Name:EAVES, MINDY (BS)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:
Last Name:EAVES
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 NW PARSON RD
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-8152
Mailing Address - Country:US
Mailing Address - Phone:812-629-3994
Mailing Address - Fax:
Practice Address - Street 1:11000 NW PARSON RD
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-8152
Practice Address - Country:US
Practice Address - Phone:812-629-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)