Provider Demographics
NPI:1164266516
Name:LIMINAL MENTAL HEALTH LLC
Entity type:Organization
Organization Name:LIMINAL MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MACPHE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:415-515-4385
Mailing Address - Street 1:2625 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2110
Mailing Address - Country:US
Mailing Address - Phone:415-515-4385
Mailing Address - Fax:
Practice Address - Street 1:314 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2829
Practice Address - Country:US
Practice Address - Phone:415-515-4385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty