Provider Demographics
NPI:1558490441
Name:DANIELS, JEAN A (LCSW, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LCSW, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9155 SW BARNES RD
Mailing Address - Street 2:SUITE 418
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6625
Mailing Address - Country:US
Mailing Address - Phone:971-270-0995
Mailing Address - Fax:503-292-4570
Practice Address - Street 1:3439 NE SANDY BLVD
Practice Address - Street 2:PMB 375
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1959
Practice Address - Country:US
Practice Address - Phone:503-284-8841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL39751041C0700X
OR201142799RN163W00000X
OR201391588NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse