Provider Demographics
NPI:1316718141
Name:WELLIFY HEALTH
Entity type:Organization
Organization Name:WELLIFY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NURSE P
Authorized Official - Prefix:
Authorized Official - First Name:TALIA
Authorized Official - Middle Name:RAM
Authorized Official - Last Name:BARUCH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:971-251-4055
Mailing Address - Street 1:1050 SW 6TH AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1153
Mailing Address - Country:US
Mailing Address - Phone:971-251-4055
Mailing Address - Fax:971-231-0183
Practice Address - Street 1:1050 SW 6TH AVE STE 1100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1153
Practice Address - Country:US
Practice Address - Phone:971-251-4055
Practice Address - Fax:971-231-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty