MEDICARE: ELIZABETH FARRELL, PMHNP, 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	:	1700457819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH FARRELL, PMHNP, LLC

Provider Business Mailing Address
First Line	:	3439 NE SANDY BLVD STE 262
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1959
Country	:	US
Telephone Number	:	503-956-9264
Fax Number	:	206-338-9984

Provider Business Practice Location Address
First Line	:	1020 SW TAYLOR ST STE 700
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2512
Country	:	US
Telephone Number	:	503-956-9264
Fax Number	:	206-338-9984

Authorized Official
Title or Position	:	OWNER & PRACTITIONER
Name	:	ELIZABETH FARRELL
Credential	:	PMHNP-BC
Telephone Number	:	503-956-9264

Provider Enumeration Date	:	07/08/2021
Last Update Date	:	03/22/2022

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