MEDICARE: MS. JENNIFER MARGARET DOUCETTE BA, MA, CADC I, QMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1124489612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER MARGARET DOUCETTE BA, MA, CADC I, QMHP

Provider Business Mailing Address
First Line	:	1321 SW WASHINGTON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2328
Country	:	US
Telephone Number	:	503-535-1171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1321 SW WASHINGTON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2328
Country	:	US
Telephone Number	:	503-535-1171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2016
Last Update Date	:	03/16/2016

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