Healthcare Provider Details

I. General information

NPI: 1922820489
Provider Name (Legal Business Name): LIVEWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7820 NE HOLMAN ST STE B7
PORTLAND OR
97218-2859
US

IV. Provider business mailing address

1224 NE WALNUT ST # 371
ROSEBURG OR
97470-2026
US

V. Phone/Fax

Practice location:
  • Phone: 509-596-1138
  • Fax: 971-308-7811
Mailing address:
  • Phone: 509-596-1138
  • Fax: 971-308-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RAGNAR SCOTT
Title or Position: FOUNDER
Credential: NP
Phone: 509-596-1138