Healthcare Provider Details

I. General information

NPI: 1639041064
Provider Name (Legal Business Name): NEW NARRATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 SW CENTER ST
TIGARD OR
97223-6307
US

IV. Provider business mailing address

8915 SW CENTER ST
TIGARD OR
97223-6307
US

V. Phone/Fax

Practice location:
  • Phone: 503-726-3740
  • Fax:
Mailing address:
  • Phone: 503-726-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LEO NICHOLAS BUKOVSAN
Title or Position: MENTAL HEALTH CLINICIAN
Credential:
Phone: 651-485-6648