=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104191451
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. JADE ELIZABETH BRINGS PLENTY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2012
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3050 SE DIVISION ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97202-1898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-489-9280
-----------------------------------------------------
Fax | 503-715-5469
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 905 SE 14TH AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97214-2569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-489-9280
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | C8935
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------