Healthcare Provider Details

I. General information

NPI: 1033024427
Provider Name (Legal Business Name): PSYCHPOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW MARSHALL ST UNIT 303
PORTLAND OR
97209-3288
US

IV. Provider business mailing address

1400 NW MARSHALL ST UNIT 303
PORTLAND OR
97209-3288
US

V. Phone/Fax

Practice location:
  • Phone: 281-569-9009
  • Fax:
Mailing address:
  • Phone: 281-569-9009
  • Fax:

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: TRANG THIEN LIEU
Title or Position: FOUNDER
Credential: NURSE PRACTITIONER
Phone: 281-569-9009