Healthcare Provider Details

I. General information

NPI: 1427359942
Provider Name (Legal Business Name): KATHERINE JONES MA, LPCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 NE KELLY AVE STE 200
GRESHAM OR
97030-5637
US

IV. Provider business mailing address

912 NE KELLY AVE STE 200
GRESHAM OR
97030-5637
US

V. Phone/Fax

Practice location:
  • Phone: 503-258-4481
  • Fax: 503-667-2580
Mailing address:
  • Phone: 503-258-4481
  • Fax: 503-667-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: