Healthcare Provider Details

I. General information

NPI: 1518233154
Provider Name (Legal Business Name): PABST PSYCHIATRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 SW VARNS ST SUITE 270
TIGARD OR
97223-8148
US

IV. Provider business mailing address

7105 SW VARNS ST SUITE 270
TIGARD OR
97223-8148
US

V. Phone/Fax

Practice location:
  • Phone: 503-389-1500
  • Fax: 800-974-5025
Mailing address:
  • Phone: 503-389-1500
  • Fax: 800-974-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201150092NP
License Number StateOR

VIII. Authorized Official

Name: DR. ANTHONY PABST
Title or Position: MEDICAL DIRECTOR
Credential: DNP, PMHNP-BC, RN
Phone: 503-389-1500