MEDICARE: HEARTBOUND COUNSELING SERVICES LIMITED LIABILITY COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1487508586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTBOUND COUNSELING SERVICES LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	13830 SW SCHOLLS FERRY RD UNIT 101
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97007-9259
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13830 SW SCHOLLS FERRY RD UNIT 101
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97007-9259
Country	:	US
Telephone Number	:	503-680-8277
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	PAUL NKEMONTOH
Credential	:	LPC
Telephone Number	:	503-680-8277

Provider Enumeration Date	:	02/25/2026
Last Update Date	:	02/25/2026

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