Healthcare Provider Details

I. General information

NPI: 1568672434
Provider Name (Legal Business Name): JESSIE BARR M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 S MACADAM AVE STE 201
PORTLAND OR
97239-6417
US

IV. Provider business mailing address

4730 S MACADAM AVE STE 201
PORTLAND OR
97239-6417
US

V. Phone/Fax

Practice location:
  • Phone: 503-278-5665
  • Fax:
Mailing address:
  • Phone: 503-278-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49460
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2642
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: