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General NPI Number Information
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NPI Number | 1881574838
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Entity Type | Organization
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Legal Business Name | ORANGE PACIFIC MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 207 N FIR ST, 2ND FLOOR
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City | SISTERS
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State | OR
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Zip | 97759
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Country | US
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Telephone | 978-328-3023
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Fax |
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Provider Business Mailing Address
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Address Line | 207 N FIR ST, 2ND FLOOR
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City | SISTERS
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State | OR
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Zip | 97759
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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 | FOUNDER
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Name | TIMOTHY KORM
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Credential | PMHNP-BC
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Telephone | 978-328-3023
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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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