Provider Demographics
NPI:1679261143
Name:PACIFIC CENTER FOR MIND AND HEALTH LLC
Entity type:Organization
Organization Name:PACIFIC CENTER FOR MIND AND HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-761-6161
Mailing Address - Street 1:319 SW WASHINGTON ST STE 1001
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-2615
Mailing Address - Country:US
Mailing Address - Phone:971-202-0677
Mailing Address - Fax:
Practice Address - Street 1:319 SW WASHINGTON ST STE 1001
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2615
Practice Address - Country:US
Practice Address - Phone:971-202-0677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty