Provider Demographics
NPI:1124680699
Name:MAH PSYCHIATRIC SERVICES INC
Entity type:Organization
Organization Name:MAH PSYCHIATRIC SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:AMBER
Authorized Official - Last Name:HARDENBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:971-727-8154
Mailing Address - Street 1:4800 SW GRIFFITH DR STE 104
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-8700
Mailing Address - Country:US
Mailing Address - Phone:971-727-8154
Mailing Address - Fax:971-246-5094
Practice Address - Street 1:4800 SW GRIFFITH DR STE 104
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-8700
Practice Address - Country:US
Practice Address - Phone:971-727-8154
Practice Address - Fax:971-246-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty