Healthcare Provider Details

I. General information

NPI: 1093239287
Provider Name (Legal Business Name): JENNIFER LYNNE BURRELL MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7327 SW BARNES RD # 618
PORTLAND OR
97225-6119
US

IV. Provider business mailing address

7327 SW BARNES RD # 618
PORTLAND OR
97225-6119
US

V. Phone/Fax

Practice location:
  • Phone: 503-743-6404
  • Fax:
Mailing address:
  • Phone: 503-743-6404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT1890
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: