Provider Demographics
NPI:1003311283
Name:LOVELL, JORDON RICHARD (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JORDON
Middle Name:RICHARD
Last Name:LOVELL
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 NE 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2821
Mailing Address - Country:US
Mailing Address - Phone:154-184-0358
Mailing Address - Fax:
Practice Address - Street 1:7000 SW VARNS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8145
Practice Address - Country:US
Practice Address - Phone:503-749-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7024101YM0800X
ORR6308101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health