Provider Demographics
NPI:1710763123
Name:DEEP INSIGHT PLLC
Entity type:Organization
Organization Name:DEEP INSIGHT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-601-8552
Mailing Address - Street 1:6400 SE LAKE RD STE 135
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2189
Mailing Address - Country:US
Mailing Address - Phone:888-830-6088
Mailing Address - Fax:888-850-5616
Practice Address - Street 1:16100 NW CORNELL RD STE 170
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7361
Practice Address - Country:US
Practice Address - Phone:971-430-2335
Practice Address - Fax:888-850-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty