Healthcare Provider Details

I. General information

NPI: 1770905556
Provider Name (Legal Business Name): JAMIE WORTHINGTON CPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 SW 14TH ST # A
REDMOND OR
97756-3007
US

IV. Provider business mailing address

947 SW 14TH ST # A
REDMOND OR
97756-3007
US

V. Phone/Fax

Practice location:
  • Phone: 775-750-9704
  • Fax:
Mailing address:
  • Phone: 775-750-9704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC7926
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1705
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: