Organization
AXIS PSYCHIATRIC SERVICES, LLC
Active
Other names
Axis Psychiatric Services LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TARRA LEANI BAKER MSN, PMHNP, NP (PSYCHIATRIC NURSE PRACTITIONER)
(615) 243-5407
Entity
Organization
Contact information
Practice address
4035 12TH ST CUT OFF SE STE 140, SALEM, OR 97302-1754
(971) 304-9306
(503) 371-2006
Mailing address
PO BOX 12926, SALEM, OR 97309-0926
(615) 243-5407
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
201701173NP-PP
OR
261QM0850X
Adult Mental Health Clinic/Center
201701173NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740736156
NPI
OR
Enumeration date
06/16/2018
Last updated
01/05/2021
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