Pegah Bakhtiyari
Individual provider Active NPI Mental Health Counselor · Wilderville, OR
NPI 1275239154 · NPPES record last updated Nov 14, 2025
Key facts
- NPI
- 1275239154
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- R12322 (OR)
- Practice address
- 13180 Redwood Hwy
Wilderville, OR 97543-9092 - Phone
- (972) 900-3816
- NPI assigned
- Feb 2, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R12322 | OR | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | R12322 | OR | Yes |
Addresses
Primary practice location
13180 Redwood Hwy
Wilderville, OR 97543-9092
Mailing address
13180 Redwood Hwy
Wilderville, OR 97543-9092
Other names
- Pegah Nischan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.