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General NPI Number Information
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NPI Number | 1194114389
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Entity Type | Individual
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Provider Name | JANA MARIE CORBETT B.SC., M.SC., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 9620 NW BERMAR LN
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City | PORTLAND
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State | OR
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Zip | 97229-5218
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Country | US
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Telephone | 971-401-8293
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Fax |
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Provider Business Mailing Address
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Address Line | 9620 NW BERMAR LN
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City | PORTLAND
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State | OR
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Zip | 97229-5218
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Country | US
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Telephone | 714-018-2939
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 18-02-05
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2811
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License Number State | OR
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