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General NPI Number Information
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NPI Number | 1063329779
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Entity Type | Organization
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Legal Business Name | AUTHENTIC PSYCHIATRIC WELLBEING LLC
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Dates
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Enumeration Date | 08/26/2026
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Last Update Date | 08/26/2026
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Provider Practice Location Address
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Address Line | 6305 FERRY ST # 2
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City | PACIFIC CITY
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State | OR
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Zip | 97135-8000
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Country | US
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Telephone | 503-932-7808
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Fax | 503-584-4253
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Provider Business Mailing Address
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Address Line | PO BOX 839
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City | PACIFIC CITY
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State | OR
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Zip | 97135-0839
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Country | US
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Telephone | 503-932-7808
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Fax | 503-584-4253
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JASON ELLIOTT
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Credential | PMHNP-C
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Telephone | 503-932-7808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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