Healthcare Provider Details

I. General information

NPI: 1881287787
Provider Name (Legal Business Name): ACTIVE RECOVERY TMS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 SE SUNNYSIDE RD STE 360
CLACKAMAS OR
97015-5705
US

IV. Provider business mailing address

11850 SW 67TH AVE STE 105
PORTLAND OR
97223-8963
US

V. Phone/Fax

Practice location:
  • Phone: 503-719-4648
  • Fax:
Mailing address:
  • Phone: 503-719-4648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY ARCHER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 971-409-5319