Healthcare Provider Details

I. General information

NPI: 1740832369
Provider Name (Legal Business Name): KIRA SANDHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2019
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 NE BAKER ST
MCMINNVILLE OR
97128-4991
US

IV. Provider business mailing address

1306 NW HOYT ST STE 407
PORTLAND OR
97209-2787
US

V. Phone/Fax

Practice location:
  • Phone: 503-435-4840
  • Fax: 503-200-1416
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR8360
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: