Organization
SACRED PSYCHIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROOSEVELT LEWIS PMHNP-BC, C-NP (OWNER)
(503) 498-6455
Entity
Organization
Contact information
Practice address
1717 NE 42ND AVE STE 100E, PORTLAND, OR 97213-1569
(503) 498-6455
Mailing address
1717 NE 42ND AVE STE 100E, PORTLAND, OR 97213-1569
(503) 498-6455
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
03/02/2021
Last updated
03/02/2021
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