Provider Demographics
NPI:1609651793
Name:CONNELL, JAYSON (COUNSELOR AFFILIATE)
Entity Type:Individual
Prefix:
First Name:JAYSON
Middle Name:
Last Name:CONNELL
Suffix:
Gender:M
Credentials:COUNSELOR AFFILIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SE 168TH AVE APT 196
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-2119
Mailing Address - Country:US
Mailing Address - Phone:360-643-3091
Mailing Address - Fax:
Practice Address - Street 1:5197 NW LOWER RIVER ROAD
Practice Address - Street 2:BUILDING #1
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660
Practice Address - Country:US
Practice Address - Phone:360-397-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)