=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265325013
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON DAWNEL GARCIA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2025
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 239 NE LINCOLN ST
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97124-3066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-238-4408
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6835 N WALL AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97203-5631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-570-4825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 25-QMHP-R-3596
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------