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General NPI Number Information
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NPI Number | 1851073464
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Entity Type | Individual
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Provider Name | LISA MARY CHILDS PMHNP
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Gender | Female
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 12655 SW CENTER ST STE 150
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City | BEAVERTON
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State | OR
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Zip | 97005-1864
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Country | US
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Telephone | 503-832-0945
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Fax |
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Provider Business Mailing Address
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Address Line | 12655 SW CENTER ST STE 150
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City | BEAVERTON
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State | OR
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Zip | 97005-1864
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Country | US
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Telephone | 503-832-0945
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 95024758
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 086006969
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10052894
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 403624
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License Number State | CA
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