Healthcare Provider Details

I. General information

NPI: 1760386247
Provider Name (Legal Business Name): JMOSSMFTLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

10620 SE LEXINGTON ST
PORTLAND OR
97266-6312
US

IV. Provider business mailing address

10620 SE LEXINGTON ST
PORTLAND OR
97266-6312
US

V. Phone/Fax

Practice location:
  • Phone: 808-281-1494
  • Fax:
Mailing address:
  • Phone: 808-281-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER MOSS
Title or Position: OWNER
Credential: MFT
Phone: 808-281-1494