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General NPI Number Information
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NPI Number | 1649117722
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Entity Type | Organization
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Legal Business Name | THE GOOD PRACTICE LLC
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Dates
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Enumeration Date | 04/29/2026
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Last Update Date | 04/29/2026
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Provider Practice Location Address
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Address Line | 24780 S BEAVERCREEK RD
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City | BEAVERCREEK
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State | OR
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Zip | 97004-8629
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Country | US
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Telephone | 323-422-2867
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Fax |
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Provider Business Mailing Address
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Address Line | 4141 NE 65TH AVE
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City | PORTLAND
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State | OR
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Zip | 97218-3225
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Country | US
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Telephone | 323-422-2867
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MONICA PROVENCE
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Credential | MA, LMFT
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Telephone | 323-422-2867
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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 |
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