Healthcare Provider Details

I. General information

NPI: 1972398089
Provider Name (Legal Business Name): MINDPEACE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 SE BELMONT ST STE 114
PORTLAND OR
97215-1675
US

IV. Provider business mailing address

4531 SE BELMONT ST STE 114
PORTLAND OR
97215-1675
US

V. Phone/Fax

Practice location:
  • Phone: 971-365-3621
  • Fax: 949-703-7718
Mailing address:
  • Phone: 971-365-3621
  • Fax: 949-703-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE H HABOUSH
Title or Position: OWNER AND CLINICIAN
Credential:
Phone: 971-365-3621