Individual
LISA MARY CHILDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
12655 SW CENTER ST STE 150, BEAVERTON, OR 97005-1864
(503) 832-0945
Mailing address
12655 SW CENTER ST STE 150, BEAVERTON, OR 97005-1864
(503) 832-0945
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
086006969
OR
163W00000X
Registered Nurse
403624
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
10052894
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95024758
CA
Other
Enumeration date
08/02/2023
Last updated
02/06/2026
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