Healthcare Provider Details

I. General information

NPI: 1285452409
Provider Name (Legal Business Name): HEALING HARBOR PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SE HIGHWAY 101 STE E2
LINCOLN CITY OR
97367-2773
US

IV. Provider business mailing address

16909 OAKDALE RD
DALLAS OR
97338-9602
US

V. Phone/Fax

Practice location:
  • Phone: 971-465-9556
  • Fax: 888-224-4514
Mailing address:
  • Phone: 503-869-3182
  • Fax: 888-224-4514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERIN S FITZGERALD
Title or Position: OWNER
Credential: PMHNP
Phone: 503-869-3182