Healthcare Provider Details

I. General information

NPI: 1316755481
Provider Name (Legal Business Name): NORTHSTAR TMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 MAIN ST
VANCOUVER WA
98660-3136
US

IV. Provider business mailing address

65 SW YAMHILL ST STE 300
PORTLAND OR
97204-3316
US

V. Phone/Fax

Practice location:
  • Phone: 503-878-8885
  • Fax:
Mailing address:
  • Phone: 503-878-8885
  • 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: TRISHA SOPHIA MARIE JONES
Title or Position: MANAGER
Credential:
Phone: 503-523-0296