Healthcare Provider Details

I. General information

NPI: 1982185500
Provider Name (Legal Business Name): JILL DENISE HENION LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILL DENISE BEAULIEU

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SE SPOKANE ST STE 321
PORTLAND OR
97202-6487
US

IV. Provider business mailing address

7969 SE BRENTWOOD CT
MILWAUKIE OR
97267-3471
US

V. Phone/Fax

Practice location:
  • Phone: 503-462-7071
  • Fax: 503-462-7072
Mailing address:
  • Phone: 503-387-9674
  • Fax: 503-462-7072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT2192
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: