SACRED PSYCHIATRY, LLC
Nurse Practitioner (Psychiatric/Mental Health)

Address: 1717 Ne 42nd Ave Ste 100e, Portland, OR 97213-1569

SACRED PSYCHIATRY, LLC (NPI# 1952996076) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1952996076
Entity Type Organization
Organization Name SACRED PSYCHIATRY, LLC
Practice Address 1717 Ne 42nd Ave Ste 100e
Portland
OR 97213-1569
Practice Telephone 5034986455
Mailing Address 1717 Ne 42nd Ave Ste 100e
Portland
OR 97213-1569
Mailing Telephone 5034986455
Certification Date 2021-03-02
Enumeration Date 2021-03-02
Last Update Date 2021-03-02
Authorized Official Telephone 5034986455
Authorized Official Credential PMHNP-BC, C-NP
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification Group License Number License State Taxonomy Group
N 363LP0808X Nurse Practitioner
Specialization: Psychiatric/Mental Health
193200000X MULTI-SPECIALTY GROUP Physician Assistants & Advanced Practice Nursing Providers
Y 261QM0801X Clinic/Center
Specialization: Mental Health (Including Community Mental Health Center)
Ambulatory Health Care Facilities

Office Location

Street Address 1717 NE 42ND AVE STE 100E
City PORTLAND
State OR
Zip Code 97213-1569

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1770956633 Russ Family Chiropractic LLC · Allbutter LLC Chiropractor 1717 Ne 42nd Ave, #3200, Portland, OR 97213-1569 2015-11-01
1730564139 Holladay & Associates, PC Clinic/Center · Mental Health (Including Community Mental Health Center) 1717 Ne 42nd Ave, Suite 2104, Portland, OR 97213-1569 2015-07-27
1669884003 Eastside Foot and Ankle Podiatrist · Foot & Ankle Surgery 1717 Ne 42nd Ave, Suite 3300, Portland, OR 97213-1569 2014-05-20
1851630339 Summer Townsend Massage Therapist 1717 Ne 42nd Ave, 3200, Portland, OR 97213-1569 2013-02-04
1558647156 Valerie Tobin, Pmhnp, LLC Clinic/Center · Mental Health (Including Community Mental Health Center) 1717 Ne 42nd Ave, Suite 2103, Portland, OR 97213-1569 2011-10-26
1144477993 Rayna E Dorsey Massage Therapist 1717 Ne 42nd Ave, Suite 100a, Portland, OR 97213-1569 2008-08-23
1093921975 Brian M. Bowen Podiatrist · Foot & Ankle Surgery 1717 Ne 42nd Ave, Suite 3300, Portland, OR 97213-1569 2007-05-15

Providers in the same zip code prefix

NPI Name Taxonomy Address Enumeration
1922696202 Kelly Landreth Community Health Worker 4400 Ne Halsey St Bldg 2 Third Floor, Portland, OR 97213 2021-01-04
1831715176 Darnell Jackie Strong Social Worker 435 Ne 78th Ave 'Strong Counseling Services', Portland, OR 97213 2020-06-23
1336775907 Redpoint Physical Therapy and Performance LLC Physical Therapist 4200 Ne Flanders St Unit B, Portland, OR 97213 2020-03-16
1801431218 Denise Dorgan-Miller Occupational Therapy Assistant Providence Elder Place, 4400 Ne Halsey Suite 200, Portland, OR 97213 2019-11-08
1619435617 Aspiration of Character Counseling Services, LLC Counselor · Addiction (Substance Use Disorder) 4424 Ne Glisan St, The Li Wellness Building, Second Floor, Portland, OR 97213 2019-03-08
1053886580 Sandy Dental Pdx Dentist 7836 Ne Sandy Blvd, Portland, OR 97213 2018-10-11
1598248072 Katelyn Boel Pharmacist 4400 Ne Halsey St, Building 2, 4th Floor, Portland, OR 97213 2018-09-11
1568944908 Shaunti Basil Physical Therapist 4805 Ne Glisan Street, Portland, OR 97213 2018-09-01
1588143432 Jessica Doskow Physical Therapist 507 Ne 47th Ave, Portland, OR 97213 2018-08-11
1578049631 Credena Health LLC Pharmacy · Community/Retail Pharmacy 4805 Ne Glisan St Ste 11n321, Portland, OR 97213 2018-07-12
Find all providers in zip 97213

Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psychiatric/Mental Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1104415405 Imani Mental Health and Wellness LLC 3939 Ne Hancock St # 202, Portland, OR 97212-5321 2021-01-12
1902493620 Portland Psychiatric Services, LLC · Portland Psychiatric Services, LLC 225 Commercial St Ste 300, Portland, ME 04101-6606 2020-12-29
1114520863 Roger Van Tunks 7105 Sw Varns St Ste 270, Portland, OR 97223-8173 2020-11-17
1457952277 Gifted Behavioral Health 510 Sw 3rd Ave Ste 200, Portland, OR 97204-2507 2020-11-06
1154920148 Hardcore Happy LLC 740 Ne 116th Ct, Portland, OR 97220-2223 2020-10-20
1558960682 Isaac Anihili Thelin 700 Ne Multnomah St Ste 275, Portland, OR 97232-4103 2020-10-20
1285231217 Malia Haddock 22 Bramhall St, Portland, ME 04102-3134 2020-10-02
1457967325 Megan L Langworthy 1914 Se 46th Ave, Portland, OR 97215-3148 2020-09-16
1386254233 Adrienne Elyse Harmon 10303 Ne Weidler St, Portland, OR 97220-1938 2020-08-05
1003425489 A'Lissa Richards · Alissa Richards 12121 E Burnside St, Portland, OR 97216-3737 2020-07-30
Find all providers in PORTLAND

Competitor

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City PORTLAND
Zip Code 97213

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.