Provider Demographics
NPI:1942196886
Name:MINDFUL PATH
Entity type:Organization
Organization Name:MINDFUL PATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORRI
Authorized Official - Middle Name:
Authorized Official - Last Name:REKART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-544-3680
Mailing Address - Street 1:4784 N LOMBARD ST STE B1077
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4565
Mailing Address - Country:US
Mailing Address - Phone:503-544-3680
Mailing Address - Fax:
Practice Address - Street 1:1733 N FARRAGUT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-6517
Practice Address - Country:US
Practice Address - Phone:503-544-3680
Practice Address - Fax:503-343-6185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty