Healthcare Provider Details

I. General information

NPI: 1033934526
Provider Name (Legal Business Name): MINDI JO ABEYTA CRM,CADC-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4585 SW 185TH AVE
ALOHA OR
97078-1557
US

IV. Provider business mailing address

4585 SW 185TH AVE
ALOHA OR
97078-1557
US

V. Phone/Fax

Practice location:
  • Phone: 503-591-9280
  • Fax: 503-848-2072
Mailing address:
  • Phone: 503-591-9280
  • Fax: 503-848-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number24-CRM-3065
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-25-4955
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: