MAH PSYCHIATRIC SERVICES, INC. (NPI# 1124680699) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124680699 |
| Entity Type | Organization |
| Organization Name | MAH PSYCHIATRIC SERVICES, INC. |
| Practice Address |
4800 Sw Griffith Dr Ste 104 Beaverton OR 97005-8700 |
| Practice Telephone | 9717278154 |
| Practice Fax Number | 9712465094 |
| Mailing Telephone | 9717278154 |
| Mailing Fax Number | 9712465094 |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2019-07-03 |
| Authorized Official Name | MICHELLE AMBER HARDENBROOK (PMHNP-BC) |
| Authorized Official Telephone | 9717278154 |
| Authorized Official Credential | NURSE PRACTITION |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Kids, Inc. | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | MAH PSYCHIATRIC SERVICES, INC | 4800 Sw Griffith Dr Ste 104, 104, Beaverton, OR 97005 |
| Street Address |
4800 SW GRIFFITH DR STE 104 |
| City | BEAVERTON |
| State | OR |
| Zip Code | 97005-8700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851603476 | Michelle Hardenbrook | Nurse Practitioner | 4800 Sw Griffith Dr Ste 104, Beaverton, OR 97005-8700 | 2010-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945053 | Krista Lowe Schimmelbusch | Student in an Organized Health Care Education/Training Program | 12730 Sw 3rd St., Beaverton, OR 97005 | 2020-06-05 |
| 1346882578 | Mireya Elissa Nunez I | Counselor | 12665 Sw Center Street, Suite 100, Beaverton, OR 97005 | 2019-10-09 |
| 1548816879 | Logan James Patzlaff | Behavior Technician | 6200 Sw Artic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-08-13 |
| 1528521424 | Alex Taylor Foerman | Behavior Technician | 6200 Sw Arctic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-04-09 |
| 1285193003 | Hazelnut Dental LLC | Clinic/Center | 10773 Sw Beaverton-hillsdale Hwy, Ste B, Beaverton, OR 97005 | 2019-03-19 |
| 1992286348 | Kathryn Wallner | Counselor | 14205 Sw Farmington Road, Suite 160, Beaverton, OR 97005 | 2018-08-23 |
| 1699265058 | Meaghan Mikulic | Social Worker | 14355 Sw Allen Blvd Suite 150, Beaverton, OR 97005 | 2018-05-11 |
| 1629568936 | Aimee J Nelson | Massage Therapist | 10700 Sw Beaverton Hillsdale Hwy Ste 465, Beaverton, OR 97005 | 2018-05-11 |
| 1093221780 | Ember Dahl | Massage Therapist | 12655 Sw Center St Ste 530, Beaverton, OR 97005 | 2017-12-18 |
| 1033667456 | Andre Vo | Pharmacist | 2575 Sw Walker Rd, Beaverton, OR 97005 | 2016-09-14 |
| Find all providers in zip 97005 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851603476 | Michelle Hardenbrook | Nurse Practitioner | 4800 Sw Griffith Dr Ste 104, Beaverton, OR 97005-8700 | 2010-07-12 |
| 1033379235 | Sherry Diane Davidson | Nurse Practitioner | 10700 Sw Beaverton-hillsdale Hwy, Park Plaza West Bld 3 Suite 547, Beaverton, OR 97005 | 2008-06-11 |
| 1720292915 | Raymond Anthony Pienczykowski Jr. | Nurse Practitioner | 1975 Nw 167th Pl, 6, Beaverton, OR 97006-4908 | 2007-05-09 |
| 1891800108 | Marianne Kandel | Nurse Practitioner | 3811-b Sw Hall Blvd, Beaverton, OR 97005-2041 | 2006-08-20 |
| 1396872032 | Heidi Louise Hart | Nurse Practitioner | 15455 Nw Greenbrier Pkwy, Suite 240, Beaverton, OR 97006-7374 | 2007-02-28 |
| 1245379650 | Christine Lynn Mccambridge | Nurse Practitioner | 9700 Sw Beaverton Hillsdale Hwy, Beaverton, OR 97005-3306 | 2007-02-05 |
| 1306947726 | Yoonhui Choe | Nurse Practitioner | 14255 Sw Brigadoon Ct, Beaverton, OR 97005-3369 | 2006-09-26 |
| 1881791515 | Linda G Krentz | Nurse Practitioner | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2006-09-17 |
| 1558384362 | Leslie J Myers | Nurse Practitioner | 16110 Sw Regatta Ln, Beaverton, OR 97006-8942 | 2006-07-25 |
| 1871516773 | Glenda A Peterson | Nurse Practitioner | 16110 Sw Regatta Ln, Beaverton, OR 97006-8942 | 2006-07-25 |
| Find all providers in BEAVERTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.