Provider Demographics
NPI:1245931666
Name:MYNDRAVYN,LLC
Entity type:Organization
Organization Name:MYNDRAVYN,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEALSADJEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-998-7072
Mailing Address - Street 1:31070 SW WILLAMETTE WAY E
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9595
Mailing Address - Country:US
Mailing Address - Phone:503-545-8688
Mailing Address - Fax:
Practice Address - Street 1:12150 SW WESTFALL RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-7207
Practice Address - Country:US
Practice Address - Phone:503-545-8688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty