Provider Demographics
NPI:1629732813
Name:PACIFICA PSYCH, LLC
Entity type:Organization
Organization Name:PACIFICA PSYCH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER; PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC (DNP)
Authorized Official - Phone:971-202-1122
Mailing Address - Street 1:PO BOX 1610
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-1610
Mailing Address - Country:US
Mailing Address - Phone:971-202-1122
Mailing Address - Fax:855-978-2666
Practice Address - Street 1:5200 MEADOWS RD STE 150
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-0066
Practice Address - Country:US
Practice Address - Phone:971-202-1122
Practice Address - Fax:855-978-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty