| Portland Neurodivergent Clinic Llc | |
|
1250 Nw Kearney St Apt 1306 Portland OR 97209-4083 | |
| (971) 202-0047 | |
| Not Available |
| Full Name | Portland Neurodivergent Clinic Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1250 Nw Kearney St Apt 1306, Portland, Oregon |
| Authorized Official Name and Position | Cassandra Fallon Miasnikov (OWNER/CLINICAL DIRECTOR) |
| Authorized Official Contact | 9712020047 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Portland Neurodivergent Clinic Llc 1250 Nw Kearney St Apt 1306 Portland OR 97209-4083 Ph: (971) 202-0047 | Portland Neurodivergent Clinic Llc 1250 Nw Kearney St Apt 1306 Portland OR 97209-4083 Ph: (971) 202-0047 |
| NPI Number | 1194549691 |
|---|---|
| Provider Enumeration Date | 11/12/2024 |
| Last Update Date | 11/12/2024 |
| Certification Date | 11/11/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194549691 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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