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General NPI Number Information
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NPI Number | 1194689786
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Entity Type | Organization
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Legal Business Name | TENACIOUS RESILIENCE MENTAL WELLNESS, LLC
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 6214 SE MILWAUKIE AVE
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City | PORTLAND
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State | OR
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Zip | 97202-5417
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Country | US
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Telephone | 503-389-5366
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Fax | 866-635-1779
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Provider Business Mailing Address
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Address Line | PO BOX 66722
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City | PORTLAND
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State | OR
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Zip | 97290-6722
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Country | US
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Telephone | 503-389-5366
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | TIMOTHY J LAFOLETTE
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Credential | PMHNP
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Telephone | 503-389-5366
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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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