Mitch Bacon LLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

T1282 Issued in OR

Legal business name

MITCH BACON LLC

Practice address

4004 SE Woodstock Blvd
#9
Portland, OR 97202-7662

Phone

(503) 766-5255

NPI assigned

Apr 4, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Mitchell Bacon, LMFTNPI 1083967442

Title

Owner

Phone

(603) 667-3282

Specialties & licenses 1

Addresses

Other names 1

• Groundpdx Doing business as

Locations

Practitioners 1

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

• Mitchell Tyler Bacon

  • Marriage & Family Therapist
  • Portland, OR
  • NPI 1083967442
  NPD (past) Authorized official

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

{
    "created_epoch": "1491264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491264000000",
    "number": "1962935312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7454 N MONTEITH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972034265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 SE WOODSTOCK BLVD",
            "address_2": "#9",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972027662",
            "telephone_number": "503-766-5255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITCH BACON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-04",
        "last_updated": "2017-04-04",
        "status": "A",
        "authorized_official_last_name": "BACON",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "603-667-3282",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "OR",
            "license": "T1282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Groundpdx",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Scott David Mist, MACOM, PHD
• Kiran Mistry, D.D.S.
• Nupur Sanghavi Mistry, MD
• Priya Patil Mistry, DDS
• Pavel Mitaru, DO
• Mitchell Physical Therapy Inc
• Ashlee Beth Mitchell Von Buttlar, PHD
• Noelle Shahnaz Mitchell-Jamal, PT, DPT
• Susan M Mitchell-Miller, FNP
• Teressa T Mitchell-Sears

• Marriage & Family Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Marriage & Family Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; 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.