Provider Demographics
NPI:1083964860
Name:LEVIN, JAMIE (LCPC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:LEVIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24998 SW BIG FIR RD
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-8607
Mailing Address - Country:US
Mailing Address - Phone:503-825-8822
Mailing Address - Fax:
Practice Address - Street 1:24998 SW BIG FIR RD
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-8607
Practice Address - Country:US
Practice Address - Phone:503-825-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2022-11-18
Deactivation Date:2019-01-11
Deactivation Code:
Reactivation Date:2022-07-19
Provider Licenses
StateLicense IDTaxonomies
IL178008445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional