Provider Demographics
NPI:1932596079
Name:PHARE, JEAN AMOUR
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:AMOUR
Last Name:PHARE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BRUCE
Other - Middle Name:MITCHELL
Other - Last Name:EVANS
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1508 SW 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3312
Mailing Address - Country:US
Mailing Address - Phone:503-891-2701
Mailing Address - Fax:
Practice Address - Street 1:1508 SW 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-3312
Practice Address - Country:US
Practice Address - Phone:503-891-2701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor