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REVAMP CREATIVE, LLC
NPI 1306523568
Clinic/Center - Adult Mental Health in Portland, OR

Active since June 29, 2023
4037 NE TILLAMOOK ST, PORTLAND, OR 97212(503) 929-7750 Get Directions Write a Review

NPPES record last updated: March 10, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 10, 2025, Apr 8, 2024 (2 updates tracked since 2024).

About Revamp Creative, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REVAMP CREATIVE, LLC (NPI 1306523568) is a healthcare organization registered as an adult mental health in Portland, Oregon and active in the NPI registry since June 2023. The organization lists Heidi Petra Davisson, Licensed Professional Counselor, as its authorized official.

NPPES Registry Identity

NPI1306523568
Entity TypeOrganization
Primary Taxonomy261QM0850X
Legal Business NameREVAMP CREATIVE, LLC
Location Address4037 NE TILLAMOOK STPortland, OR 97212-5341
Mailing Address63 Ne Thompson StPortland, OR 97212-3741 · (503) 929-7750
Phone(503) 929-7750
Organization SubpartNo
Authorized OfficialHeidi Petra DavissonLicensed Professional Counselor · (503) 929-7750
Enumeration DateJune 29, 2023
Last NPPES UpdateMarch 10, 20252 updates tracked since enumeration
NPPES CertifiedMarch 10, 2025
✔ NPI 1306523568 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 7

★ Primary SpecialtyClinic/Center · Adult Mental HealthAmbulatory Health Care Facilities
Taxonomy Code261QM0850X
Definition

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
Also ListedCase ManagementTaxonomy 251B00000X
Also ListedCommunity/Behavioral HealthTaxonomy 251S00000X
Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X
Also ListedClinic/Center · Adolescent and Children Mental HealthTaxonomy 261QM0855X
Also ListedCommunity Based Residential Treatment Facility, Mental IllnessTaxonomy 320800000X
4037 NE TILLAMOOK ST, Portland, OR 97212
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Moda Health Plan, Inc., Regence BlueCross BlueShield of Oregon.Insurance ›

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. EDWARD F GREEN M.D.
Psychiatry & Neurology (Psychiatry)
4037 NE TILLAMOOK ST
PORTLAND, OR 97212
Multnomah County (503) 736-3292
ALISON LEE DANIELS LCSW
Social Worker (Clinical)
4037 NE TILLAMOOK ST
PORTLAND, OR 97212
Multnomah County (503) 310-9456

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Revamp Creative, LLC's NPI number?

The NPI number for Revamp Creative, LLC is 1306523568. It was assigned to this organization in the NPPES registry on June 29, 2023.

Where is Revamp Creative, LLC located?

Revamp Creative, LLC is located at 4037 NE Tillamook St, Portland, OR 97212. The listed phone number is (503) 929-7750.

What is Revamp Creative, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Adult Mental Health, with taxonomy code 261QM0850X.

What insurance does Revamp Creative, LLC accept?

Health plans from BridgeSpan Health Company, Moda Health Plan, Inc. and Regence BlueCross BlueShield of Oregon list Revamp Creative, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Revamp Creative, LLC was last updated on March 10, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.