Mira Mahendra Cavanaugh, MA, LPC, ATR

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C3985 Issued in OR

Practice address

12578 SW Broadway St
Beaverton, OR 97005-2136

Phone

(503) 367-3268

NPI assigned

Jan 21, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1453334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547769600000",
    "number": "1306203344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13001 SW 63RD PL",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972198068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12578 SW BROADWAY ST",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970052136",
            "telephone_number": "503-367-3268"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12525 SW 3rd St",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970050517",
            "country_code": "US",
            "telephone_number": "503-367-3268",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAVANAUGH",
        "first_name": "MIRA",
        "middle_name": "MAHENDRA",
        "credential": "MA, LPC, ATR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-21",
        "last_updated": "2019-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C3985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2019; 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.