| Axis Psychiatric Services Llc | |
|
4035 12th St Cut Off Se Ste 140 Salem OR 97302-1754 | |
| (971) 304-9306 | |
| (503) 371-2006 |
| Full Name | Axis Psychiatric Services Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4035 12th St Cut Off Se Ste 140, Salem, Oregon |
| Authorized Official Name and Position | Tarra Leani Baker (PSYCHIATRIC NURSE PRACTITIONER) |
| Authorized Official Contact | 6152435407 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Axis Psychiatric Services Llc Po Box 12926 Salem OR 97309-0926 Ph: (615) 243-5407 | Axis Psychiatric Services Llc 4035 12th St Cut Off Se Ste 140 Salem OR 97302-1754 Ph: (971) 304-9306 |
| NPI Number | 1457845182 |
|---|---|
| Provider Enumeration Date | 06/16/2018 |
| Last Update Date | 01/05/2021 |
| Certification Date | 01/05/2021 |
| Medicare PECOS PAC ID | 6800148479 |
|---|---|
| Medicare Enrollment ID | O20181009002379 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457845182 | NPI | - | NPPES |
| 1740736156 | Other | OR | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 201701173NP-PP (Oregon) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | 201701173NP-PP (Oregon) | Secondary |
| Provider Name | Tarra Leani Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740736156 PECOS PAC ID: 9032491592 Enrollment ID: I20181009002422 |
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