NPIMap

Heather Louise Mirasol, M.A., LPC

Individual provider Active NPI Mental Health Counselor · Gresham, OR

NPI 1295885069 · NPPES record last updated Jun 29, 2025

Key facts

NPI
1295885069
Entity type
Individual (NPI type 1)
Primary specialty
Mental Health Counselor 101YM0800X
License
C2670 (OR)
Practice address
649 NE Hood Ave
Gresham, OR 97030-7328
Phone
(971) 404-4668
Fax
(971) 273-2708
NPI assigned
Jan 11, 2007
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
C2670ORMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Connected Space Counseling, LLC Current
since Jul 9, 2025		 Accepting new patients

Locations

649 NE Hood Ave
Gresham, OR 97030
Phone (971) 404-4668

1201 SE 223rd Ave
Ste 165
Gresham, OR 97030
Phone (971) 404-4668

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.heathermirasol@148835.advancedmd-direct.com

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X C2670 OR Yes

Addresses

Primary practice location

649 NE Hood Ave
Gresham, OR 97030-7328

Mailing address

1201 SE 223Rd Ave Ste 165
Gresham, OR 97030-2577
Phone (971) 404-4668

Other providers in Gresham, OR

All providers in Gresham, OR · Mental Health Counselor in Oregon

Sources for this page

Verify at the official NPI Registry.