Provider Demographics
NPI:1518233154
Name:PABST PSYCHIATRIC GROUP
Entity Type:Organization
Organization Name:PABST PSYCHIATRIC GROUP
Other - Org Name:PORTLAND PSYCHIATRIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PABST
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC, RN
Authorized Official - Phone:503-389-1500
Mailing Address - Street 1:7105 SW VARNS ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8148
Mailing Address - Country:US
Mailing Address - Phone:503-389-1500
Mailing Address - Fax:800-974-5025
Practice Address - Street 1:7105 SW VARNS ST
Practice Address - Street 2:SUITE 270
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8148
Practice Address - Country:US
Practice Address - Phone:503-389-1500
Practice Address - Fax:800-974-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X, 1041C0700X
OR201150092NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR163701Medicare UPIN