Provider Demographics
NPI:1568672434
Name:HARRIS, JESSIE ISIS BARR (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:ISIS BARR
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SW MAIN ST
Mailing Address - Street 2:SUITE 1950
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-3228
Mailing Address - Country:US
Mailing Address - Phone:503-720-4359
Mailing Address - Fax:
Practice Address - Street 1:101 SW MAIN ST
Practice Address - Street 2:SUITE 1950
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-3228
Practice Address - Country:US
Practice Address - Phone:503-720-4359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
CA49460106H00000X
ORC2642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist