Organization
AT HOME PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MINDY MILAR MOORE PMHNP (OWNER)
(888) 667-6467
Entity
Organization
Contact information
Practice address
7975 SW 83RD AVE, PORTLAND, OR 97223-7334
(888) 667-6467
(888) 667-6467
Mailing address
8959 SW BARBUR BLVD STE 115, PORTLAND, OR 97219-4032
(888) 667-6467
(888) 667-6467
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
200850112NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500623422
—
OR
Enumeration date
09/17/2017
Last updated
02/07/2019
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