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General NPI Number Information
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NPI Number | 1760811087
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Entity Type | Organization
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Legal Business Name | QUIET MIND MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 1722 NW RALEIGH ST # 211
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City | PORTLAND
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State | OR
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Zip | 97209-1753
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Country | US
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Telephone | 971-282-2346
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Fax |
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Provider Business Mailing Address
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Address Line | 7122 NE 10TH AVE
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City | PORTLAND
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State | OR
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Zip | 97211-4004
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Country | US
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Telephone | 971-282-2346
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MICHELLE ROBERTS
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Credential |
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Telephone | 971-282-2346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 201250209NP
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License Number State | OR
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