NPIMap

Organization Active NPI

Mindtree Holistic Counseling & Wellness Center LLC

  • Marriage & Family Therapist
  • Portland, OR
National Provider Identifier
1922692995
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
MINDTREE HOLISTIC COUNSELING & WELLNESS CENTER LLC
Practice address
5440 SW Westgate Dr Ste 210
Portland, OR 97221-2418
Phone
(503) 766-4895
Fax
(503) 716-4699
NPI assigned
Feb 21, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Authorized official

Name
Ms. Sreeharini Sukumaran, LMFTNPI 1376912766
Title
Owner / Director
Phone
(503) 927-1656

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

5440 SW Westgate Dr Ste 210
Portland, OR 97221-2418

Mailing address

5440 SW Westgate Dr Ste 210
Portland, OR 97221-2418
Phone (503) 766-4895

Other names 1

  • MindTree Other name

National Provider Directory

National Provider Directory

Locations

5440 SW Westgate Dr
Ste 210
Portland, OR 97221
Phone (503) 766-4895

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1613865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1922692995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5440 SW WESTGATE DR STE 210",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212418",
            "telephone_number": "503-766-4895",
            "fax_number": "503-716-4699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5440 SW WESTGATE DR STE 210",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212418",
            "telephone_number": "503-766-4895",
            "fax_number": "503-716-4699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDTREE HOLISTIC COUNSELING & WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-21",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "SUKUMARAN",
        "authorized_official_first_name": "SREEHARINI",
        "authorized_official_title_or_position": "OWNER / DIRECTOR",
        "authorized_official_telephone_number": "503-927-1656",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MindTree",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Mar 29, 2021; 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.