Organization
MINDFUL AWAKENINGS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS RYANN MISHELL MOORE LCSW (MANAGER/OWNER)
(503) 706-8413
Entity
Organization
Contact information
Practice address
4511 SE HAWTHORNE BLVD, SUITE 204, PORTLAND, OR 97215-3182
(503) 706-8413
Mailing address
4324 NE 57TH AVE, PORTLAND, OR 97218-2241
(912) 381-5898
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
5355
OR
Other
Enumeration date
03/01/2017
Last updated
03/01/2017
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