Provider Demographics
NPI:1619343027
Name:HEAD, JASON M
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:HEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:MILTON
Other - Last Name:HEAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC1,CRM
Mailing Address - Street 1:900 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:503-208-2596
Practice Address - Street 1:2602 ARBOR DR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-1104
Practice Address - Country:US
Practice Address - Phone:503-387-3884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-5-14101YA0400X
OR17-CRM-032175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)