Healthcare Provider Details

I. General information

NPI: 1093625352
Provider Name (Legal Business Name): SUNSTONE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 SE CLINTON ST STE C
PORTLAND OR
97202-1241
US

IV. Provider business mailing address

2612 SE CLINTON ST STE C
PORTLAND OR
97202-1241
US

V. Phone/Fax

Practice location:
  • Phone: 503-395-8222
  • Fax:
Mailing address:
  • Phone: 503-395-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARY CHAKHTOURA
Title or Position: OWNER, MENTAL HEALTH THERAPIST
Credential: LCSW
Phone: 503-395-8222