Provider Demographics
NPI:1104236819
Name:A HEALING INTENTION, LLC
Entity type:Organization
Organization Name:A HEALING INTENTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MIYASATO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-906-7870
Mailing Address - Street 1:12725 SW MILLIKAN WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1678
Mailing Address - Country:US
Mailing Address - Phone:503-906-7870
Mailing Address - Fax:503-906-7871
Practice Address - Street 1:12725 SW MILLIKAN WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1678
Practice Address - Country:US
Practice Address - Phone:503-906-7870
Practice Address - Fax:503-906-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5855251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500670052Medicaid