Provider Demographics
NPI:1780298778
Name:RUSHALL, JAY LAWRENCE (LMHC, NCC)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:LAWRENCE
Last Name:RUSHALL
Suffix:
Gender:M
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:RUSHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:714 SE 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3118
Mailing Address - Country:US
Mailing Address - Phone:760-815-7288
Mailing Address - Fax:
Practice Address - Street 1:714 SE 35TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3118
Practice Address - Country:US
Practice Address - Phone:760-815-7288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-07
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health