Active NPI
Over the Moon Psychiatry LLC
- Psychiatric/Mental Health Nurse Practitioner
- Portland, OR
National Provider Identifier
1689578676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- Legal business name
- OVER THE MOON PSYCHIATRY LLC
- Practice address
- 7573 N Edgewater Ave
Portland, OR 97203-5081 - Phone
- (915) 319-0828
- NPI assigned
- Oct 5, 2026
- Last updated
- Oct 5, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jacob Joseph Tullius, NP
- Title
- Owner
- Phone
- (915) 319-0828
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | NU | Primary |
Addresses
Primary practice location
7573 N Edgewater Ave
Portland, OR 97203-5081
Mailing address
7573 N Edgewater Ave
Portland, OR 97203-5081
Phone (915) 319-0828
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Psychiatric/Mental Health Nurse Practitioner
- Portland, OR
- NPI 1578418075
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1791158400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1791158400000",
"number": "1689578676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7573 N EDGEWATER AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972035081",
"telephone_number": "915-319-0828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7573 N EDGEWATER AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972035081",
"telephone_number": "915-319-0828"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OVER THE MOON PSYCHIATRY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-10-05",
"last_updated": "2026-10-05",
"certification_date": "2026-10-05",
"status": "A",
"authorized_official_last_name": "TULLIUS",
"authorized_official_first_name": "JACOB",
"authorized_official_middle_name": "JOSEPH",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "915-319-0828",
"authorized_official_credential": "NP"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.