Healthcare Provider Details

I. General information

NPI: 1336623602
Provider Name (Legal Business Name): VISTAS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E POWELL BLVD STE 212
GRESHAM OR
97030-7622
US

IV. Provider business mailing address

123 E POWELL BLVD STE 212
GRESHAM OR
97030-7622
US

V. Phone/Fax

Practice location:
  • Phone: 971-777-3272
  • Fax: 844-364-1335
Mailing address:
  • Phone: 971-777-3272
  • Fax: 844-364-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DINA LYNN YEREX
Title or Position: OWNER
Credential: LPC
Phone: 971-226-4040