PROVIDENCE HEALTH & SERVICES OREGON NPI 1033804091

NPI Information

  • NPI: 1033804091
  • Provider Name: PROVIDENCE HEALTH & SERVICES OREGON
  • Classification: Psychiatry & Neurology - 2084P0802X
  • Specialization: Addiction Psychiatry
  • Entity Type: Organization
  • :
  • CLIA Number: 38D0898204
  • Address: 4400 NE HALSEY ST, BLDG 2
    STE 599
    PORTLAND, OR
    ZIP 97213
  • Phone: (503) 215-2110

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NPI Details

PROVIDENCE HEALTH & SERVICES OREGON is an addiction psychiatry psychiatry neurology in Portland, OR. The provider is addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. PROVIDENCE HEALTH & SERVICES OREGON NPI is 1033804091. The provider is registered as an organization entity type and is a multi-specialty group.
The provider .

The provider's business location address is:

4400 NE HALSEY ST, BLDG 2
STE 599
PORTLAND, OR
ZIP 97213-721
Phone: (503) 215-2110

The provider's authorized official is Donald Wayne Anderson .
The authorized official title is Assistant Secretary Of Enrollments and has the following contact phone number (425) 358-9786.

The CLIA number assigned to this NPI record is 38D0898204 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/6/2023 and was last updated on 6/20/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12084P0802XPsychiatry & NeurologyAddiction PsychiatryYes

What is NPI?

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This page was last updated on: 11/21/2025

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