NPIMap

Organization Active NPI

Mandala Mental and Behavioral Health, LLC

  • Professional Counselor
  • Portland, OR
National Provider Identifier
1104333103
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
C4036 Issued in OR
Legal business name
MANDALA MENTAL AND BEHAVIORAL HEALTH, LLC
Practice address
650 NE Holladay St Ste 16001614
Portland, OR 97232-2045
Phone
(503) 367-3630
Fax
(503) 224-3126
NPI assigned
Dec 29, 2017
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel J Gilbride, MA, MRC, LPCNPI 1942662150
Title
Director
Phone
(503) 367-3630

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X C4036 OR Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X OR
Community/Behavioral Health Agency 251S00000X C4036 OR

Addresses

Primary practice location

650 NE Holladay St Ste 16001614
Portland, OR 97232-2045

Mailing address

650 NE Holladay St Ste 1600
Portland, OR 97232-2035
Phone (503) 367-3630

Other practice location 1

511 SW 10th Ave Ste 601
Portland, OR 97205-2707
Phone (503) 367-3630

Other practice location 2

650 NE Holladay St Ste 16001614
Portland, OR 97232-2045
Phone (503) 367-3630

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1514505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1104333103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 NE HOLLADAY ST STE 1600",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322035",
            "telephone_number": "503-367-3630",
            "fax_number": "503-224-3126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 NE HOLLADAY ST STE 16001614",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322045",
            "telephone_number": "503-367-3630",
            "fax_number": "503-224-3126"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "511 SW 10th Ave Ste 601",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972052707",
            "country_code": "US",
            "telephone_number": "503-367-3630",
            "fax_number": "503-224-3126",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "650 NE Holladay St Ste 16001614",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972322045",
            "country_code": "US",
            "telephone_number": "503-367-3630",
            "fax_number": "503-224-3126",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MANDALA MENTAL AND BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-29",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "GILBRIDE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "503-367-3630",
        "authorized_official_credential": "MA, MRC, LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C4036",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OR",
            "license": "C4036",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.