MEDICARE: HEALING HARBOR PSYCHIATRY

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	:	1285452409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING HARBOR PSYCHIATRY

Provider Business Mailing Address
First Line	:	16909 OAKDALE RD
Second Line	:
City	:	DALLAS
State	:	OR
Zip	:	97338-9602
Country	:	US
Telephone Number	:	503-869-3182
Fax Number	:	888-224-4514

Provider Business Practice Location Address
First Line	:	820 SE HIGHWAY 101 STE E2
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-2773
Country	:	US
Telephone Number	:	971-465-9556
Fax Number	:	888-224-4514

Authorized Official
Title or Position	:	OWNER
Name	:	ERIN S FITZGERALD
Credential	:	PMHNP
Telephone Number	:	503-869-3182

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	02/26/2025

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