Basic Information
| Provider Information | |||||||||
| NPI: | 1780320382 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEARD | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | STERLING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1425 SW CLAY ST APT 304 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972016008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6086172627 | ||||||||
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| Practice Location | |||||||||
| Address1: | 222 SE 8TH AVE STE 212 | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971234218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033527333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2022 | ||||||||
| LastUpdateDate: | 05/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.