Healthcare Provider Details

I. General information

NPI: 1073452280
Provider Name (Legal Business Name): ASPEN PSYCHIATRY NORTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19365 SW 65TH AVE
TUALATIN OR
97062-9196
US

IV. Provider business mailing address

19365 SW 65TH AVE
TUALATIN OR
97062-9196
US

V. Phone/Fax

Practice location:
  • Phone: 202-703-9896
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LU
Title or Position: PMHNP
Credential:
Phone: 202-703-9896