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NPI Code Detail

MEDICARE: SOFIA JASANI MS, NCC, LPC INTERN

MEDICARE: SOFIA JASANI MS, NCC, LPC INTERN
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
1101YP2500XProfessional CounselorR6541OR

General Provider Information

NPI Number : 1205419264
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOFIA JASANI MS, NCC, LPC INTERN
Provider Business Mailing Address
First Line : 1061 NE 9TH AVE APT 1329
Second Line :
City : PORTLAND
State : OR
Zip : 97232-3500
Country : US
Telephone Number : 541-801-3610
Fax Number :
Provider Business Practice Location Address
First Line : 1061 NE 9TH AVE APT 1329
Second Line :
City : PORTLAND
State : OR
Zip : 97232-3500
Country : US
Telephone Number : 541-801-3610
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2021
Last Update Date : 04/28/2021

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