Provider Demographics
NPI:1881272144
Name:BERGREEN, PHILLIP MICHAEL (DNP, PMHNP)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:MICHAEL
Last Name:BERGREEN
Suffix:
Gender:M
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8459
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-8459
Mailing Address - Country:US
Mailing Address - Phone:503-238-0769
Mailing Address - Fax:503-764-9042
Practice Address - Street 1:17070 SE MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-4960
Practice Address - Country:US
Practice Address - Phone:503-303-4000
Practice Address - Fax:503-344-4412
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202215624NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty