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General NPI Number Information
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NPI Number | 1942196886
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Entity Type | Organization
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Legal Business Name | MINDFUL PATH
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 10/12/2025
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Provider Practice Location Address
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Address Line | 1733 N FARRAGUT ST
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City | PORTLAND
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State | OR
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Zip | 97217-6517
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Country | US
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Telephone | 503-544-3680
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Fax | 503-343-6185
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Provider Business Mailing Address
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Address Line | 4784 N LOMBARD ST STE B1077
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City | PORTLAND
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State | OR
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Zip | 97203-4565
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Country | US
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Telephone | 971-357-2061
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Fax | 971-357-2561
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Authorized Official
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Title or Position | OWNER
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Name | CORRI REKART
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Credential |
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Telephone | 503-544-3680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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