Provider Demographics
NPI:1639560329
Name:GREEN-JONES, ISAIAH (MSW QMHP)
Entity Type:Individual
Prefix:MR
First Name:ISAIAH
Middle Name:
Last Name:GREEN-JONES
Suffix:
Gender:M
Credentials:MSW QMHP
Other - Prefix:
Other - First Name:ISAIAH
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1027 E. BURNSIDE ST.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:503-239-8400
Mailing Address - Fax:503-269-8407
Practice Address - Street 1:3550 N INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1196
Practice Address - Country:US
Practice Address - Phone:503-648-0753
Practice Address - Fax:503-648-0755
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health