Provider Demographics
NPI:1780875195
Name:RICHARDS, JONELLE MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:JONELLE
Middle Name:MARIE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 SW HAMPTON ST
Mailing Address - Street 2:SUITE 128
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8315
Mailing Address - Country:US
Mailing Address - Phone:503-639-2390
Mailing Address - Fax:503-598-7055
Practice Address - Street 1:7100 SW HAMPTON ST
Practice Address - Street 2:SUITE 128
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8315
Practice Address - Country:US
Practice Address - Phone:503-639-2390
Practice Address - Fax:503-598-7055
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical