Healthcare Provider Details

I. General information

NPI: 1699693093
Provider Name (Legal Business Name): MENTAL HEALTH NW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 MEADOWS RD # 317
LAKE OSWEGO OR
97035-4264
US

IV. Provider business mailing address

4800 MEADOWS RD # 317
LAKE OSWEGO OR
97035-4264
US

V. Phone/Fax

Practice location:
  • Phone: 503-208-5713
  • Fax: 971-307-2021
Mailing address:
  • Phone: 503-208-5713
  • Fax: 971-307-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SOPHIE STACH
Title or Position: OWNER
Credential:
Phone: 503-208-5713