Healthcare Provider Details

I. General information

NPI: 1336044650
Provider Name (Legal Business Name): BANIN AL-HADDAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15383 S GRAVES RD
MULINO OR
97042-9789
US

IV. Provider business mailing address

15383 S GRAVES RD
MULINO OR
97042-9789
US

V. Phone/Fax

Practice location:
  • Phone: 503-860-1566
  • Fax: 360-210-1350
Mailing address:
  • Phone: 503-860-1566
  • Fax: 360-210-1350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: