Organization
MANDALA MENTAL AND BEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL J GILBRIDE MA, MRC, LPC (DIRECTOR)
(503) 367-3630
Entity
Organization
Contact information
Practice address
650 NE HOLLADAY ST STE 16001614, PORTLAND, OR 97232-2045
(503) 367-3630
(503) 224-3126
Mailing address
650 NE HOLLADAY ST STE 1600, PORTLAND, OR 97232-2035
(503) 367-3630
(503) 224-3126
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C4036
OR
1041C0700X
Clinical Social Worker
—
OR
251S00000X
Community/Behavioral Health Agency
C4036
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13804154
NATIONAL PROVIDER NUMBER, TERESA CONLAN
—
01
—
1942662150
NATIONAL PROVIDER NUMBER, DANIEL GILBRIDE
—
Enumeration date
12/29/2017
Last updated
06/16/2018
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