Healthcare Provider Details

I. General information

NPI: 1255245296
Provider Name (Legal Business Name): TRANQUILITY SUMMIT PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 SE SUNNYSIDE RD STE 300
CLACKAMAS OR
97015-5713
US

IV. Provider business mailing address

13203 SE 172ND AVE SUITE 166 PMB 2000
HAPPY VALLEY OR
97086-8738
US

V. Phone/Fax

Practice location:
  • Phone: 503-455-7864
  • Fax: 503-386-3345
Mailing address:
  • Phone: 503-455-7864
  • Fax: 503-386-3345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: VICTORIA JENSEN JENSEN
Title or Position: PMHNP-BC
Credential: PMHNP-BC
Phone: 503-455-7864