Provider Demographics
NPI:1538709738
Name:ELLIS, SCHUYLER BLAKE (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:SCHUYLER
Middle Name:BLAKE
Last Name:ELLIS
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 1:5621 SE 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5426
Mailing Address - Country:US
Mailing Address - Phone:785-817-5968
Mailing Address - Fax:
Practice Address - Street 1:308 NW 11TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2980
Practice Address - Country:US
Practice Address - Phone:503-379-1902
Practice Address - Fax:503-217-2023
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61052586163WP0808X
OR202001267RN163WP0808X
WAAP61052588363LP0808X
OR202001770NP-PP363LP0808X, 363LP0808X
TXAP144884363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health