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General NPI Number Information
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NPI Number | 1316752033
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Entity Type | Organization
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Legal Business Name | ACTIVE RECOVERY TMS PLLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 2525 12TH ST SE STE 210
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City | SALEM
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State | OR
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Zip | 97302-2281
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Country | US
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Telephone | 206-210-1198
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Fax | 503-914-1401
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Provider Business Mailing Address
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Address Line | 11850 SW 67TH AVE STE 105
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City | PORTLAND
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State | OR
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Zip | 97223-8963
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CONTRACTOR
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Name | AMY DAWN MOORE
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Credential |
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Telephone | 503-819-6585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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