Healthcare Provider Details

I. General information

NPI: 1841784725
Provider Name (Legal Business Name): WELL COAST PSYCHIATRIC INC. A NURSING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 07/17/2022
Certification Date: 07/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10260 SW GREENBURG RD FL 4
TIGARD OR
97223-5500
US

IV. Provider business mailing address

11575 SW PACIFIC HWY # 40452
TIGARD OR
97223-8671
US

V. Phone/Fax

Practice location:
  • Phone: 888-923-5486
  • Fax: 866-225-9111
Mailing address:
  • Phone: 888-923-5486
  • Fax: 866-225-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95002431
License Number StateCA

VIII. Authorized Official

Name: ERIK LEE
Title or Position: OWNER
Credential: PMHNP
Phone: 888-923-5486