MEDICARE: TENACIOUS RESILIENCE MENTAL WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1194689786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENACIOUS RESILIENCE MENTAL WELLNESS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 66722
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97290-6722
Country	:	US
Telephone Number	:	503-389-5366
Fax Number	:

Provider Business Practice Location Address
First Line	:	6214 SE MILWAUKIE AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-5417
Country	:	US
Telephone Number	:	503-389-5366
Fax Number	:	866-635-1779

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	TIMOTHY J LAFOLETTE
Credential	:	PMHNP
Telephone Number	:	503-389-5366

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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