Healthcare Provider Details

I. General information

NPI: 1184142283
Provider Name (Legal Business Name): JAMI L STEPHENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 NE 4TH ST STE 110
GRESHAM OR
97030-7496
US

IV. Provider business mailing address

406 NE 4TH ST STE 110
GRESHAM OR
97030-7496
US

V. Phone/Fax

Practice location:
  • Phone: 503-516-0573
  • Fax: 503-674-9740
Mailing address:
  • Phone: 503-516-0573
  • Fax: 503-674-9740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC2676
License Number StateOR

VIII. Authorized Official

Name: JAMI L STEPHENS
Title or Position: OWNER
Credential: MA, CT, LPC
Phone: 503-516-0573