Provider Demographics
NPI:1205419264
Name:JASANI, SOFIA (MS, NCC, LPC INTERN)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:JASANI
Suffix:
Gender:F
Credentials:MS, NCC, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 NE 9TH AVE APT 1329
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3500
Mailing Address - Country:US
Mailing Address - Phone:541-801-3610
Mailing Address - Fax:
Practice Address - Street 1:1061 NE 9TH AVE APT 1329
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3500
Practice Address - Country:US
Practice Address - Phone:541-801-3610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional