Provider Demographics
NPI:1316198872
Name:WILLIAMS, DAMON MICHAEL (RN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:DAMON
Middle Name:MICHAEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SW OAK ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1817
Mailing Address - Country:US
Mailing Address - Phone:503-988-3663
Mailing Address - Fax:503-988-4098
Practice Address - Street 1:426 SW STARK ST FL 5
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2347
Practice Address - Country:US
Practice Address - Phone:503-988-5140
Practice Address - Fax:503-988-5180
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACNS 3098364SP0808X
CANP 18387363LP0808X
OR200950172NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health