Organization
MITCH BACON LLC
Active
Other names
Groundpdx
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MITCHELL BACON LMFT (OWNER)
(603) 667-3282
Entity
Organization
Contact information
Practice address
4004 SE WOODSTOCK BLVD, #9, PORTLAND, OR 97202-7662
(503) 766-5255
Mailing address
7454 N MONTEITH AVE, PORTLAND, OR 97203-4265
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
T1282
OR
Other
Enumeration date
04/04/2017
Last updated
04/04/2017
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