Healthcare Provider Details

I. General information

NPI: 1679351993
Provider Name (Legal Business Name): JESSE LEE MORRIS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 SE LAKE RD STE 155
PORTLAND OR
97222-2137
US

IV. Provider business mailing address

8132 MYSTICAL LN SE
SALEM OR
97317-8967
US

V. Phone/Fax

Practice location:
  • Phone: 503-447-3285
  • Fax: 503-917-4971
Mailing address:
  • Phone: 971-239-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10016058
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: