Organization · Type 2 NPI
Inner Domain Holistic Health, LLC
Psychiatric/Mental Health Nurse Practitioner · Portland, OR
NPI number
1720965908
Active
Practice location
2700 SE 26th Ave Ste D
Portland, OR 97202-1288
Fax (503) 388-3977
Mailing address
4110 SE Hawthorne Blvd # 217
Portland, OR 97214-5246
Other practice locations
- 6700 SW 105th Ave Ste 211, Beaverton, OR 97008-8824 · (503) 974-4624
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | None listed |
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | None listed |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
4 other providers at this address
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About NPI 1720965908
Inner Domain Holistic Health, LLC's National Provider Identifier is 1720965908, issued on Aug 19, 2025. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Portland, OR. The record was last updated on Jan 27, 2026.