Jack S Bodily
Counselor, Mental Health in Portland, OR. Individual provider (NPI-1).
NPI number1982103834
StatusActive
Last updated in NPPESFeb 6, 2018
Details
- NPI
- 1982103834
- Entity type
- Individual (NPI-1)
- Name
- Jack S Bodily
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 6, 2018
- Last updated
- Feb 6, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | – | – | Yes |
Practice location
17720 Ne Halsey St Ste BPortland, OR 97230-6771
Phone 503-654-7654 · Fax 503-654-7333
Mailing address
3587 Heathrow WayMedford, OR 97504-4004
Phone 541-858-8170 · Fax 541-858-8167
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