Provider Demographics
NPI:1326257379
Name:ROPER, JASON MICHAEL (MS)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:MICHAEL
Last Name:ROPER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 DAN AVE
Mailing Address - Street 2:
Mailing Address - City:OLIVEHURST
Mailing Address - State:CA
Mailing Address - Zip Code:95961-8107
Mailing Address - Country:US
Mailing Address - Phone:530-741-6275
Mailing Address - Fax:530-749-7913
Practice Address - Street 1:4240 DAN AVE
Practice Address - Street 2:
Practice Address - City:OLIVEHURST
Practice Address - State:CA
Practice Address - Zip Code:95961-8107
Practice Address - Country:US
Practice Address - Phone:530-741-6275
Practice Address - Fax:530-749-7913
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060280844101YS0200X
CAMFC 46889106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool