Provider Demographics
NPI:1538454178
Name:CATHERINE SAMSON, PMHNP, LLC
Entity type:Organization
Organization Name:CATHERINE SAMSON, PMHNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:LOTT
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:503-679-6470
Mailing Address - Street 1:2455 NW MARSHALL ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2949
Mailing Address - Country:US
Mailing Address - Phone:503-679-6470
Mailing Address - Fax:503-296-2996
Practice Address - Street 1:2455 NW MARSHALL ST
Practice Address - Street 2:SUITE 14
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2949
Practice Address - Country:US
Practice Address - Phone:503-679-6470
Practice Address - Fax:503-296-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-11
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR200650006NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty