Provider Demographics
NPI:1558647156
Name:VALERIE TOBIN, PMHNP, LLC
Entity Type:Organization
Organization Name:VALERIE TOBIN, PMHNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:503-318-8568
Mailing Address - Street 1:1717 NE 42ND AVE.
Mailing Address - Street 2:SUITE 2103
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213
Mailing Address - Country:US
Mailing Address - Phone:503-318-8568
Mailing Address - Fax:
Practice Address - Street 1:1717 NE 42ND AVE
Practice Address - Street 2:SUITE 2103
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1569
Practice Address - Country:US
Practice Address - Phone:503-318-8568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650134NP261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)