Healthcare Provider Details

I. General information

NPI: 1992471676
Provider Name (Legal Business Name): NEUPATHWAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2021
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12725 SW MILLIKAN WAY STE 300
BEAVERTON OR
97005-1687
US

IV. Provider business mailing address

12725 SW MILLIKAN WAY STE 300
BEAVERTON OR
97005-1687
US

V. Phone/Fax

Practice location:
  • Phone: 971-319-1592
  • Fax: 971-999-0925
Mailing address:
  • Phone: 971-319-1592
  • Fax: 971-999-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. GABRIEL TAYLOR-PARSONS
Title or Position: OWNER
Credential: APRN
Phone: 971-319-1592