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General NPI Number Information
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NPI Number | 1023922853
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Entity Type | Organization
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Legal Business Name | EMBODIED CONSCIOUSNESS
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 7825 SW 36TH AVE STE 204
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City | PORTLAND
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State | OR
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Zip | 97219-1689
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Country | US
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Telephone | 971-266-7176
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Fax |
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Provider Business Mailing Address
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Address Line | 7695 SW HILLCREST PL
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City | BEAVERTON
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State | OR
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Zip | 97008-5823
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Country | US
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Telephone | 971-266-7176
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY D HIRSTEIN
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Credential | LPC
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Telephone | 971-266-7176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | NULL
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