# MITCH BACON LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Groundpdx
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962935312
- **Authorized official:** MR. MITCHELL BACON LMFT (OWNER)
- **Authorized official phone:** (603) 667-3282

## Contact information

- **Practice address:** 4004 SE WOODSTOCK BLVD, \#9, PORTLAND, OR 97202-7662
- **Practice address phone:** (503) 766-5255
- **Mailing address:** 7454 N MONTEITH AVE, PORTLAND, OR 97203-4265

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | T1282 | OR | Yes |

## Other

- **Enumeration date:** 04/04/2017
- **Last updated:** 04/04/2017