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General NPI Number Information
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NPI Number | 1194613778
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Entity Type | Organization
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Legal Business Name | ANTARA PSYCHIATRY LLC
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 1110 SE ALDER ST STE 301
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City | PORTLAND
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State | OR
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Zip | 97214-2400
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Country | US
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Telephone | 503-765-5914
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 SE ALDER ST STE 301
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City | PORTLAND
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State | OR
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Zip | 97214-2400
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Country | US
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Telephone | 503-765-5914
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Fax | 870-229-1352
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE SHOBHA MOKASHI
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Credential | MD
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Telephone | 503-765-5914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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