Healthcare Provider Details

I. General information

NPI: 1902727357
Provider Name (Legal Business Name): MINDFUL ACTIONS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6162 WALINA CT SE
SALEM OR
97317-9534
US

IV. Provider business mailing address

780 COMMERCIAL ST SE STE 201
SALEM OR
97301-3463
US

V. Phone/Fax

Practice location:
  • Phone: 503-383-9201
  • Fax:
Mailing address:
  • Phone: 503-383-9201
  • 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: ELESHIA LEDRIDGE
Title or Position: OWNER
Credential: MA., LPC
Phone: 503-383-9201