=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255245296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANQUILITY SUMMIT PSYCHIATRIC SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2026
-----------------------------------------------------
Last Update Date | 09/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10121 SE SUNNYSIDE RD STE 300
-----------------------------------------------------
City | CLACKAMAS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97015-5713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-455-7864
-----------------------------------------------------
Fax | 503-386-3345
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13203 SE 172ND AVE SUITE 166 PMB 2000
-----------------------------------------------------
City | HAPPY VALLEY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97086-8738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-455-7864
-----------------------------------------------------
Fax | 503-386-3345
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP-BC
-----------------------------------------------------
Name | VICTORIA JENSEN JENSEN
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 503-455-7864
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------