Provider Demographics
NPI:1487191797
Name:LIFESPAN PSYCHIATRIC CONSULTING, LLC
Entity Type:Organization
Organization Name:LIFESPAN PSYCHIATRIC CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:VILIUS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:503-491-5896
Mailing Address - Street 1:955 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7418
Mailing Address - Country:US
Mailing Address - Phone:503-491-5896
Mailing Address - Fax:888-972-9783
Practice Address - Street 1:955 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7418
Practice Address - Country:US
Practice Address - Phone:503-491-5896
Practice Address - Fax:888-972-9783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20070075NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty