=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437004512
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PORTLAND PSYCHOTHERAPY PSYCHIATRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2026
-----------------------------------------------------
Last Update Date | 03/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3700 N WILLIAMS AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97227-1441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-281-4852
-----------------------------------------------------
Fax | 503-575-3711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3700 N WILLIAMS AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97227-1441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-281-4852
-----------------------------------------------------
Fax | 503-575-3711
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JASON LUOMA
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 971-378-6094
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------