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).
| 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 |
| 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 |
| Street Address | 1717 NE 42ND AVE STE 100E |
| City | PORTLAND |
| State | OR |
| Zip Code | 97213-1569 |
| 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 |
| 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 Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psychiatric/Mental Health |
| Definition to come... |
| 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 | ||||
| City | PORTLAND |
| Zip Code | 97213 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326671447 | Sacred Heart Psychiatry Pa | Psychiatry & Neurology · Psychiatry | 4907 Van Dyke Rd, Lutz, FL 33558-4813 | 2020-02-17 |
| 1841811908 | Sacred Hearts Psychiatry & Addiction Medicine | Clinic/Center | 7047 E Greenway Pkwy Ste 250, Scottsdale, AZ 85254-8113 | 2020-04-29 |
| 1578097002 | Helen Y. Choi, Md · Sacred Heart Psychiatry | Psychiatry & Neurology · Psychiatry | 16554 N Dale Mabry Hwy, Tampa, FL 33618-1325 | 2017-04-11 |
| 1376533281 | Sacred Heart Healthcare System · Sacred Heart Medical Associates | Family Medicine | 421 W Chew St, Sacred Heart Hospital, Allentown, PA 18102-3406 | 2005-10-24 |
| 1851630057 | Sacred Heart Hospital of Pensacola · Sacred Heart Hand Center/Sacred Heart Medical Group | Orthopaedic Surgery · Hand Surgery | 4551-A North Davis Hwy, Pensacola, FL 32503-2782 | 2013-02-07 |
| 1780240614 | Sacred Wandering / Sacred Path Practitioners | Clinic/Center · Mental Health (Including Community Mental Health Center) | 10134 N Port Washington Rd Ste G, Mequon, WI 53092-5700 | 2019-05-16 |
| 1497992671 | Sacred Heart Foundation, Inc · Sacred Family Hospice | Hospice Care, Community Based | 15255 N 40th St, Suite 125, Phoenix, AZ 85032-4624 | 2009-01-09 |
| 1912155839 | Sacred Heart Care Center Inc · Sacred Heart Assisted Li Ving Apartments | Assisted Living Facility | 1202 12th St Sw, Austin, MN 55912-2616 | 2008-09-04 |
| 1043768807 | Sacred Space Healing & Retreat Center International, Inc. · Sacred Space Retreats | Substance Abuse Rehabilitation Facility | 627 Cherry Creek Rd., Box 311, Cloverdale, CA 95425 | 2016-09-21 |
| 1093769275 | Sacred Heart Hospital · Sacred Heart Visiting Nurses | Home Health | 2268 S 12th St, Fourth Floor, Allentown, PA 18103-5642 | 2006-05-20 |
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| 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.