Provider Demographics
NPI:1427887744
Name:MINDFUL OREGON CLINIC
Entity type:Organization
Organization Name:MINDFUL OREGON CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YEKEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:971-270-0116
Mailing Address - Street 1:1915 NE STUCKI AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6951
Mailing Address - Country:US
Mailing Address - Phone:971-325-7537
Mailing Address - Fax:
Practice Address - Street 1:1915 NE STUCKI AVE STE 308
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006-6951
Practice Address - Country:US
Practice Address - Phone:971-270-0116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty