Provider Demographics
NPI:1184142283
Name:JAMI L STEPHENS
Entity type:Organization
Organization Name:JAMI L STEPHENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CT, LPC
Authorized Official - Phone:503-516-0573
Mailing Address - Street 1:406 NE 4TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7496
Mailing Address - Country:US
Mailing Address - Phone:503-516-0573
Mailing Address - Fax:503-674-9740
Practice Address - Street 1:406 NE 4TH ST STE 110
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7496
Practice Address - Country:US
Practice Address - Phone:503-516-0573
Practice Address - Fax:503-674-9740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2676101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty