NPI 1902128804 · live from the CMS NPI Registry
Basic Mindfulness Portland, LLC
Psychologist, Clinical in Portland, OR. National Provider Identifier 1902128804, active.
NPI record
| NPI | 1902128804 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Psychologist, Clinical 103TC0700X |
| Practice location | 1920 Nw Johnson St, Suite 103, Portland, OR 97209 |
| Practice phone | 503-719-5499 |
| Enumerated | February 18, 2010 |
| Last updated | February 18, 2010 |
| Authorized official | Janet Sims, Co-Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Social Worker, Clinical | 1041C0700X | 4220 (OR) |
| Psychologist, Clinical primary | 103TC0700X | 1978 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.