| A Healing Intention, Llc | |
|
12725 Sw Millikan Way Suite 300 Beaverton OR 97005-1678 | |
| (503) 906-7870 | |
| (503) 906-7871 |
| Full Name | A Healing Intention, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 12725 Sw Millikan Way, Beaverton, Oregon |
| Authorized Official Name and Position | Kevin C Miyasato (OWNER) |
| Authorized Official Contact | 5039067870 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Healing Intention, Llc 12725 Sw Millikan Way Suite 300 Beaverton OR 97005-1678 Ph: (503) 906-7870 | A Healing Intention, Llc 12725 Sw Millikan Way Suite 300 Beaverton OR 97005-1678 Ph: (503) 906-7870 |
| NPI Number | 1104236819 |
|---|---|
| Provider Enumeration Date | 05/02/2014 |
| Last Update Date | 06/06/2014 |
| Medicare PECOS PAC ID | 9335363126 |
|---|---|
| Medicare Enrollment ID | O20140618000613 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104236819 | NPI | - | NPPES |
| 500670052 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 5855 (Oregon) | Primary |
| Provider Name | Kevin Charles Miyasato |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184902504 PECOS PAC ID: 2860616661 Enrollment ID: I20140618000803 |
| Provider Name | Andrew R Vogler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003366378 PECOS PAC ID: 7214346105 Enrollment ID: I20210505001595 |
| Provider Name | Regina E Vander |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518001734 PECOS PAC ID: 1153730791 Enrollment ID: I20210511001506 |
| Provider Name | Sara Abbott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629600259 PECOS PAC ID: 9032569306 Enrollment ID: I20231228002521 |
| Provider Name | Destiny Marie Bankhead |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114273471 PECOS PAC ID: 6406398015 Enrollment ID: I20240611002988 |
| Provider Name | Jenna Urban |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700221629 PECOS PAC ID: 4981147204 Enrollment ID: I20240614002494 |
| Provider Name | Elizabeth K La Torella |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1316272941 PECOS PAC ID: 1658814645 Enrollment ID: I20240621001078 |
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