MEDICARE: MIRANDA YORK LMFT INC

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	:	1821956095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRANDA YORK LMFT INC

Provider Business Mailing Address
First Line	:	4401 SE TENINO ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-0957
Country	:	US
Telephone Number	:	206-683-6637
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 SE TENINO ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-0957
Country	:	US
Telephone Number	:	206-683-6637
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIRANDA BLYTHE YORK
Credential	:	LMFT
Telephone Number	:	206-683-6637

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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