Provider Demographics
NPI:1790864718
Name:JONES, BARRY TRAVIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:TRAVIS
Last Name:JONES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15110 S.W. BOONES FERRY RD.
Mailing Address - Street 2:STE. 350
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3461
Mailing Address - Country:US
Mailing Address - Phone:503-349-0810
Mailing Address - Fax:
Practice Address - Street 1:15110 BOONES FERRY RD
Practice Address - Street 2:STE. 350
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3468
Practice Address - Country:US
Practice Address - Phone:503-349-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0417103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000TCHWQMedicare ID - Type Unspecified