Organization
MOONSTONE MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIE PETERSON MSN (PMHNP-BC)
(503) 443-8339
Entity
Organization
Contact information
Practice address
7110 SW FIR LOOP STE 145, TIGARD, OR 97223-8031
(503) 389-5882
Mailing address
7110 SW FIR LOOP STE 145, TIGARD, OR 97223-8031
(503) 389-5882
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/02/2024
Last updated
01/20/2025
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