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Individual

MR. SCHUYLER BLAKE ELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PMHNP-BC

Contact information

Practice address
308 NW 11TH AVE FL 2, PORTLAND, OR 97209-2980
(503) 379-1902
(503) 217-2023
Mailing address
5621 SE 65TH AVE, PORTLAND, OR 97206-5426
(785) 817-5968

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
202001267RN
OR
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN61052586
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202001770NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP61052588
WA

Other

Enumeration date
01/15/2020
Last updated
12/19/2022
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