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General NPI Number Information
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NPI Number | 1790495802
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Entity Type | Organization
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Legal Business Name | SARVIS MENTAL HEALTH INC
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 5 CENTERPOINTE DR STE 400
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-8661
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Country | US
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Telephone | 503-217-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 2647 CREEKWOOD DR
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City | CEDAR HILL
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State | TX
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Zip | 75104-6939
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Country | US
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Telephone | 503-705-8310
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMUEL JOSEPH CROSS-SARVIS
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Credential | NP
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Telephone | 503-217-4455
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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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