Jason David Wallis, LPC
Counselor, Professional in Portland, OR. Individual provider (NPI-1).
NPI number1396913331
StatusActive
Last updated in NPPESApr 17, 2025
Details
- NPI
- 1396913331
- Entity type
- Individual (NPI-1)
- Name
- Jason David Wallis
- Credential
- LPC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 12, 2008
- Certification date
- Apr 17, 2025
- Last updated
- Apr 17, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YP2500X | Counselor, Professional | C7443 | OR | Yes |
Practice location
2901 E Burnside StPortland, OR 97214-1831
Phone 503-953-0310
Mailing address
3500 Ne Martin Luther King Jr Blvd Ste 200Portland, OR 97212-2093
Phone 503-655-8264 · Fax 503-953-2454
Other practice locations
3500 Ne Martin Luther King Jr Blvd Ste 200
Portland, OR 97212-2093
Portland, OR 97212-2093
Phone 503-496-3201
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