REVAMP CREATIVE LLC NPI 1306523568

NPI Information

NPI: 1306523568
Provider Name: REVAMP CREATIVE, LLC
Classification: Clinic/Center - 261QM0850X
Specialization: Adult Mental Health
Entity Type: Organization
Address: 4037 NE TILLAMOOK ST
PORTLAND, OR
ZIP 97212
Phone: (503) 929-7750

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NPI Details

REVAMP CREATIVE, LLC is an adult mental health clinic center in Portland, OR. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. REVAMP CREATIVE, LLC NPI is 1306523568. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4037 NE TILLAMOOK ST
PORTLAND, OR
ZIP 97212-341
Phone: (503) 929-7750

The provider's authorized official is Heidi Petra Davisson .
The authorized official title is Licensed Professional Counselor and has the following contact phone number (503) 929-7750.

The enumeration date for this NPI number is 6/29/2023 and was last updated on 3/10/2025.

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	Primary
1	101YM0800X	Counselor	Mental Health	No
2	251B00000X	Case Management		No
3	251S00000X	Community/Behavioral Health		No
4	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	No
5	261QM0850X	Clinic/Center	Adult Mental Health	Yes
6	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	No
7	320800000X	Community Based Residential Treatment Facility, Mental Illness		No

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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