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General NPI Number Information
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NPI Number | 1629732813
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Entity Type | Organization
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Legal Business Name | PACIFICA PSYCH, LLC
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 5200 MEADOWS RD STE 150
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-0066
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Country | US
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Telephone | 971-202-1122
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Fax | 855-978-2666
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Provider Business Mailing Address
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Address Line | PO BOX 1610
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City | SCAPPOOSE
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State | OR
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Zip | 97056-1610
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Country | US
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Telephone | 971-202-1122
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Fax | 855-978-2666
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Authorized Official
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Title or Position | OWNER; PROVIDER
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Name | DR. KELLY ALDINGER
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Credential | PMHNP-BC (DNP)
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Telephone | 971-202-1122
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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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