Healthcare Provider Details

I. General information

NPI: 1669150884
Provider Name (Legal Business Name): DEEP INSIGHT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 SE LAKE RD STE 135
PORTLAND OR
97222-2189
US

IV. Provider business mailing address

6400 SE LAKE RD STE 135
PORTLAND OR
97222-2189
US

V. Phone/Fax

Practice location:
  • Phone: 888-830-6088
  • Fax: 888-850-5616
Mailing address:
  • Phone: 888-830-6088
  • Fax: 503-447-3285

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: MRS. JILL CARTER
Title or Position: OWNER
Credential: FNP
Phone: 971-430-2335