Summer Breeayn Ardianto

Individual provider Active NPI Mental Health Counselor · McMinnville, OR

NPI 1972361996 · NPPES record last updated Mar 13, 2024

Key facts

NPI
1972361996
Entity type
Individual (NPI type 1)
Primary specialty
Mental Health Counselor 101YM0800X
Practice address
2274 SW 2ND St Ste D
McMinnville, OR 97128-5597
Phone
(503) 372-5147
Fax
(503) 266-8632
NPI assigned
Mar 13, 2024
Sex
Female
Sole proprietor
Yes

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

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

Addresses

Primary practice location

2274 SW 2ND St Ste D
McMinnville, OR 97128-5597

Mailing address

113 N Elm St
Canby, OR 97013-3519
Phone (503) 263-8903

Other practice location 1

5289 NE Elam Young Pkwy Ste 140
Hillsboro, OR 97124-7551
Phone (503) 372-5147

Other providers in McMinnville, OR

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

Sources for this page

Verify at the official NPI Registry.