MEDICARE: HIDDEN VISION LLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1740023019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIDDEN VISION LLC

Provider Business Mailing Address
First Line	:	1020 SW TAYLOR ST STE 535
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2527
Country	:	US
Telephone Number	:	503-841-7211
Fax Number	:	503-841-7211

Provider Business Practice Location Address
First Line	:	1020 SW TAYLOR ST STE 535
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2527
Country	:	US
Telephone Number	:	503-841-7211
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA ATALLA
Credential	:	MS, CRC, LPC
Telephone Number	:	503-841-7211

Provider Enumeration Date	:	06/14/2024
Last Update Date	:	06/14/2024

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Directions to “HIDDEN VISION LLC ” Practice Location

Language	Start Address	Practice Location

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