Provider Demographics
NPI:1730638677
Name:DARIEN, JAY (BA, MA)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:DARIEN
Suffix:
Gender:M
Credentials:BA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18000 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7013
Mailing Address - Country:US
Mailing Address - Phone:503-596-2063
Mailing Address - Fax:503-486-7802
Practice Address - Street 1:18000 SW UPPER BOONES FERRY RD
Practice Address - Street 2:A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7013
Practice Address - Country:US
Practice Address - Phone:503-596-2063
Practice Address - Fax:503-486-7802
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR3488101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health