Provider Demographics
NPI:1922692995
Name:MINDTREE HOLISTIC COUNSELING & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:MINDTREE HOLISTIC COUNSELING & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SREEHARINI
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKUMARAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:503-927-1656
Mailing Address - Street 1:5440 SW WESTGATE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2418
Mailing Address - Country:US
Mailing Address - Phone:503-766-4895
Mailing Address - Fax:503-716-4699
Practice Address - Street 1:5440 SW WESTGATE DR STE 210
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2418
Practice Address - Country:US
Practice Address - Phone:503-766-4895
Practice Address - Fax:503-716-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-21
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty