Provider Demographics
NPI:1790305233
Name:PINE MOUNTAIN COUNSELING
Entity Type:Organization
Organization Name:PINE MOUNTAIN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MFT
Authorized Official - Phone:503-455-4305
Mailing Address - Street 1:PO BOX 19932
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97280-0932
Mailing Address - Country:US
Mailing Address - Phone:503-455-4305
Mailing Address - Fax:
Practice Address - Street 1:7805 SW 40TH AVE UNIT 19932
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1643
Practice Address - Country:US
Practice Address - Phone:503-455-4305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700281730OtherNPI AS SOLE PROPRIETOR