| Healing Tides Counseling, Llc | |
|
2450 Se Belmont St Portland OR 97214-2821 | |
| (503) 887-2555 | |
| (503) 212-0969 |
| Full Name | Healing Tides Counseling, Llc |
|---|---|
| Speciality | Counselor |
| Location | 2450 Se Belmont St, Portland, Oregon |
| Authorized Official Name and Position | Shanako Devoll (OWNER/THERAPIST) |
| Authorized Official Contact | 5038876255 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healing Tides Counseling, Llc 3439 Ne Sandy Blvd # 313 Portland OR 97232-1959 Ph: (503) 887-6255 | Healing Tides Counseling, Llc 2450 Se Belmont St Portland OR 97214-2821 Ph: (503) 887-2555 |
| NPI Number | 1578146106 |
|---|---|
| Provider Enumeration Date | 05/02/2021 |
| Last Update Date | 04/27/2023 |
| Certification Date | 04/27/2023 |
| Medicare PECOS PAC ID | 0547608853 |
|---|---|
| Medicare Enrollment ID | O20240405001413 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578146106 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Shanako M Devoll |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316254022 PECOS PAC ID: 8426324328 Enrollment ID: I20240510001723 |
| Provider Name | Elisia Lopez-mendiola |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528371358 PECOS PAC ID: 4587993811 Enrollment ID: I20240521002590 |
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