Healthcare Provider Details

I. General information

NPI: 1144152349
Provider Name (Legal Business Name): MINDWELL MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 82ND DR STE 5
GLADSTONE OR
97027-2562
US

IV. Provider business mailing address

45 82ND DR STE 5
GLADSTONE OR
97027-2562
US

V. Phone/Fax

Practice location:
  • Phone: 503-446-8152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PAMELA CORLEY
Title or Position: CO-OWNER
Credential: PMHNP
Phone: 503-446-8152