Healthcare Provider Details

I. General information

NPI: 1386389740
Provider Name (Legal Business Name): MINDFULNESS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2022
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SW BEAVERTON HILLSDALE HWY STE 560
BEAVERTON OR
97005-4791
US

IV. Provider business mailing address

12725 SW MILLIKAN WAY STE 300
BEAVERTON OR
97005-1687
US

V. Phone/Fax

Practice location:
  • Phone: 503-208-6511
  • Fax:
Mailing address:
  • Phone: 503-758-9185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY KATHLEEN SESTERO
Title or Position: OWNER, THERAPIST
Credential: LPC, LMHC, NCC
Phone: 503-208-6511