Provider Demographics
NPI:1033934526
Name:ABEYTA, MINDI JO (CRM,CADC-R)
Entity type:Individual
Prefix:
First Name:MINDI
Middle Name:JO
Last Name:ABEYTA
Suffix:
Gender:F
Credentials:CRM,CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4585 SW 185TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97078-1557
Mailing Address - Country:US
Mailing Address - Phone:503-591-9280
Mailing Address - Fax:503-848-2072
Practice Address - Street 1:4585 SW 185TH AVE
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97078-1557
Practice Address - Country:US
Practice Address - Phone:503-591-9280
Practice Address - Fax:503-848-2072
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-CRM-3065175T00000X
ORT-25-4955101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)