| Mighty Oak Aba Llc | |
|
327 Se 139th Ave Portland OR 97233-1849 | |
| (818) 427-6126 | |
| Not Available |
| Full Name | Mighty Oak Aba Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 327 Se 139th Ave, Portland, Oregon |
| Authorized Official Name and Position | Nirvana Kowlessar-hirshleifer (OWNER) |
| Authorized Official Contact | 8184276126 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mighty Oak Aba Llc 327 Se 139th Ave Portland OR 97233-1849 Ph: () - | Mighty Oak Aba Llc 327 Se 139th Ave Portland OR 97233-1849 Ph: (818) 427-6126 |
| NPI Number | 1477148641 |
|---|---|
| Provider Enumeration Date | 03/09/2021 |
| Last Update Date | 03/09/2021 |
| Certification Date | 03/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477148641 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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