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General NPI Number Information
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NPI Number | 1841050952
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Entity Type | Organization
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Legal Business Name | MEEHA MINDBODY LLC
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Dates
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Enumeration Date | 03/19/2024
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 2916 NE BROADWAY ST
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City | PORTLAND
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State | OR
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Zip | 97232-1897
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Country | US
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Telephone | 503-894-6888
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Fax | 503-427-9553
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Provider Business Mailing Address
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Address Line | 1500 NE 15TH AVE APT 241
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City | PORTLAND
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State | OR
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Zip | 97232-4415
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Country | US
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Telephone | 773-354-6789
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Fax | 503-427-9553
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Authorized Official
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Title or Position | OWNER
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Name | DENISE ADAN
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Credential | LAC
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Telephone | 773-354-6789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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