Provider Demographics
NPI:1215024377
Name:NORTHWEST PSYCHIATRIC GROUP, PC
Entity Type:Organization
Organization Name:NORTHWEST PSYCHIATRIC GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-827-0298
Mailing Address - Street 1:921 SW WASHINGTON ST
Mailing Address - Street 2:SUITE 460
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2827
Mailing Address - Country:US
Mailing Address - Phone:503-827-0298
Mailing Address - Fax:503-827-0299
Practice Address - Street 1:921 SW WASHINGTON ST
Practice Address - Street 2:SUITE 460
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2827
Practice Address - Country:US
Practice Address - Phone:503-827-0298
Practice Address - Fax:503-827-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD229752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty