Healthcare Provider Details

I. General information

NPI: 1548124308
Provider Name (Legal Business Name): WHITE MOUNTAIN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 NE DEKUM ST
PORTLAND OR
97211-3628
US

IV. Provider business mailing address

5404 SE MILWAUKIE AVE
PORTLAND OR
97202-4914
US

V. Phone/Fax

Practice location:
  • Phone: 503-825-8501
  • Fax:
Mailing address:
  • Phone: 978-979-6094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MENASCO
Title or Position: OWNER
Credential: LCSW
Phone: 978-979-6094