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General NPI Number Information
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NPI Number | 1972398089
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Entity Type | Organization
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Legal Business Name | MINDPEACE MENTAL HEALTH LLC
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 4531 SE BELMONT ST STE 114
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City | PORTLAND
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State | OR
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Zip | 97215-1675
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Country | US
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Telephone | 971-365-3621
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Fax | 949-703-7718
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Provider Business Mailing Address
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Address Line | 4531 SE BELMONT ST STE 114
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City | PORTLAND
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State | OR
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Zip | 97215-1675
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Country | US
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Telephone | 971-365-3621
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Fax | 949-703-7718
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Authorized Official
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Title or Position | OWNER AND CLINICIAN
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Name | CHRISTINE H HABOUSH
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Credential |
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Telephone | 971-365-3621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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