Provider Demographics
NPI:1396357745
Name:VASQUEZ, JASON (QMHP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CENTERPOINTE DR STE 320
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8696
Mailing Address - Country:US
Mailing Address - Phone:971-213-2837
Mailing Address - Fax:541-858-8167
Practice Address - Street 1:5 CENTERPOINTE DR STE 320
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8696
Practice Address - Country:US
Practice Address - Phone:971-213-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-QMHP-R-2685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health