Healthcare Provider Details

I. General information

NPI: 1053636001
Provider Name (Legal Business Name): JAMIE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE FLEMING

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25050 SE STARK ST STE 300
GRESHAM OR
97030-3388
US

IV. Provider business mailing address

PO BOX 8459
PORTLAND OR
97207-8459
US

V. Phone/Fax

Practice location:
  • Phone: 35-667-8878
  • Fax: 503-667-0310
Mailing address:
  • Phone: 503-238-0769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7778
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: