Provider Demographics
NPI:1972398089
Name:MINDPEACE MENTAL HEALTH LLC
Entity type:Organization
Organization Name:MINDPEACE MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:H
Authorized Official - Last Name:HABOUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-365-3621
Mailing Address - Street 1:4531 SE BELMONT ST STE 114
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1675
Mailing Address - Country:US
Mailing Address - Phone:971-365-3621
Mailing Address - Fax:949-703-7718
Practice Address - Street 1:4531 SE BELMONT ST STE 114
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1675
Practice Address - Country:US
Practice Address - Phone:971-365-3621
Practice Address - Fax:949-703-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty