NPI 1407300205 · live from the CMS NPI Registry
Jenna Abernathy, MA, LPC Intern, LMT
Counselor, Mental Health in Portland, OR. National Provider Identifier 1407300205, active.
NPI record
| NPI | 1407300205 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Counselor, Mental Health 101YM0800X |
| Practice location | 3537 N Williams Ave, Portland, OR 97227 |
| Practice phone | 503-309-8622 |
| Mailing address | 4545 Ne Mallory Ave, Portland, OR 97211 |
| Enumerated | August 9, 2016 |
| Last updated | December 4, 2019 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Massage Therapist | 225700000X | 10987 (OR) |
| Counselor, Mental Health primary | 101YM0800X | — (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.