Provider Demographics
NPI:1366859175
Name:GOMES, VICTOR (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:GOMES
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CENTERPOINTE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8661
Mailing Address - Country:US
Mailing Address - Phone:503-543-1034
Mailing Address - Fax:
Practice Address - Street 1:12503 SE MILL PLAIN BLVD STE 123
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4007
Practice Address - Country:US
Practice Address - Phone:360-334-9942
Practice Address - Fax:425-242-3683
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201403830RN163WP0808X
171M00000X
OR10006901363LP0808X
WAAP61421622363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator