| Active Recovery Tms Pllc | |
|
4949 Meadows Rd Ste 250 Lake Oswego OR 97035-3147 | |
| (503) 308-3007 | |
| Not Available |
| Full Name | Active Recovery Tms Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 4949 Meadows Rd Ste 250, Lake Oswego, Oregon |
| Authorized Official Name and Position | Y Pritham K Raj (CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 5033083007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Active Recovery Tms Pllc 4949 Meadows Rd Ste 250 Lake Oswego OR 97035-3147 Ph: (503) 836-5014 | Active Recovery Tms Pllc 4949 Meadows Rd Ste 250 Lake Oswego OR 97035-3147 Ph: (503) 308-3007 |
| NPI Number | 1881287787 |
|---|---|
| Provider Enumeration Date | 02/11/2021 |
| Last Update Date | 02/11/2021 |
| Certification Date | 02/11/2021 |
| Medicare PECOS PAC ID | 9032528047 |
|---|---|
| Medicare Enrollment ID | O20210504001021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881287787 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Y Pritham Raj |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972690923 PECOS PAC ID: 8325047814 Enrollment ID: I20061211000419 |
| Provider Name | Laura Dillard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083036990 PECOS PAC ID: 1153683297 Enrollment ID: I20180329001112 |
| Provider Name | Jenna Lander |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366989832 PECOS PAC ID: 6608112560 Enrollment ID: I20190114002162 |
| Provider Name | Ryan Dozler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134793615 PECOS PAC ID: 0143696773 Enrollment ID: I20221021001470 |
| Provider Name | Larissa Birndorf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073939211 PECOS PAC ID: 7719290451 Enrollment ID: I20230206001148 |
| Provider Name | Zachary Ray Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508430216 PECOS PAC ID: 8325443708 Enrollment ID: I20231026001032 |
| Provider Name | Yasmin Malik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194036814 PECOS PAC ID: 4284070962 Enrollment ID: I20240316000378 |
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