Provider Demographics
NPI:1235673070
Name:JONES-BIGBOY, AUTUMN (CADC-R/CRM/PSS)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:JONES-BIGBOY
Suffix:
Gender:F
Credentials:CADC-R/CRM/PSS
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:JONES-BIGBOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC-R/CRM/PSS
Mailing Address - Street 1:10564 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2809
Mailing Address - Country:US
Mailing Address - Phone:503-228-9229
Mailing Address - Fax:
Practice Address - Street 1:1631 SW COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-6025
Practice Address - Country:US
Practice Address - Phone:503-231-2641
Practice Address - Fax:503-231-1654
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16-CRM-163101YA0400X
ORTHW0001464175T00000X
ORT-18-383101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500730706Medicaid
OR500755072Medicaid