Provider Demographics
NPI:1235375981
Name:BHARGAVA, MAMTA (NCC, LPC)
Entity type:Individual
Prefix:MRS
First Name:MAMTA
Middle Name:
Last Name:BHARGAVA
Suffix:
Gender:
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 SW VESTA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7452
Mailing Address - Country:US
Mailing Address - Phone:480-252-2860
Mailing Address - Fax:
Practice Address - Street 1:4351 SW VESTA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-7452
Practice Address - Country:US
Practice Address - Phone:480-252-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 13800101YP2500X
ORC8032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional