Healthcare Provider Details

I. General information

NPI: 1164273835
Provider Name (Legal Business Name): PRESENT MIND COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 SE BELMONT ST STE 118
PORTLAND OR
97215-1675
US

IV. Provider business mailing address

4531 SE BELMONT ST STE 118
PORTLAND OR
97215-1675
US

V. Phone/Fax

Practice location:
  • Phone: 503-406-8456
  • Fax:
Mailing address:
  • Phone: 503-406-8456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: EVAN EGENER
Title or Position: OWNER AND MANAGER
Credential: MA, LPC
Phone: 503-406-8456