Provider Demographics
NPI:1225777907
Name:RISE UP MENTAL HEALTH, LLC.
Entity Type:Organization
Organization Name:RISE UP MENTAL HEALTH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO, PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:PEATS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:619-733-9698
Mailing Address - Street 1:9700 SW CAPITOL HWY STE 105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5274
Mailing Address - Country:US
Mailing Address - Phone:619-733-9698
Mailing Address - Fax:
Practice Address - Street 1:9700 SW CAPITOL HWY STE 105
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5274
Practice Address - Country:US
Practice Address - Phone:619-733-9698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336716372OtherNPI