MEDICARE: JASON M HEAD

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	15-5-14	OR
2	175T00000X	Peer Specialist	17-CRM-032	OR

General Provider Information

NPI Number	:	1619343027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON M HEAD

Provider Business Mailing Address
First Line	:	900 MAIN ST STE 200
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-1869
Country	:	US
Telephone Number	:
Fax Number	:	503-208-2596

Provider Business Practice Location Address
First Line	:	2602 ARBOR DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-1104
Country	:	US
Telephone Number	:	503-387-3884
Fax Number	:

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

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	12/05/2019

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Directions to “ JASON M HEAD ” Practice Location

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