Provider Demographics
NPI:1295885069
Name:MIRASOL, HEATHER LOUISE (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LOUISE
Last Name:MIRASOL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1700 NW CIVIC DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3770
Mailing Address - Country:US
Mailing Address - Phone:503-666-8832
Mailing Address - Fax:503-669-8841
Practice Address - Street 1:1700 NW CIVIC DR
Practice Address - Street 2:SUITE 310
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3770
Practice Address - Country:US
Practice Address - Phone:503-666-8832
Practice Address - Fax:503-669-8841
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC2670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health