person
Jennifer Nicole Petty
Mental Health Counselor in Portland, Oregon
NPI 1396480893

Jennifer Nicole Petty is a Mental Health Counselor based in Portland, OR and is specialized in Mental Health. Jennifer Nicole Petty practices in Portland, OR. The NPI Number for Jennifer Nicole Petty is 1396480893 and holds a License No. (Oregon).

The current practice location address for Jennifer Nicole Petty is 621 Sw Alder St Ste 520, Portland, OR and can be reached out via phone at 503-418-5311 and via fax at 503-494-4747.

Location: 621 Sw Alder St Ste 520, Portland, OR, 97205-3620
person
Provider Profile Details
NPI Number
1396480893
Provider Name
Jennifer Nicole Petty
Credential
Provider Entity Type
Individual
Gender
Female
Address
621 Sw Alder St Ste 520, Portland, OR, 97205-3620
Phone Number
503-418-5311
Fax Number
503-494-4747
Provider Enumeration Date
04/29/2022
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
101YM0800X 05 OR
institution
Provider Business Practice Location Address Details
Address
621 Sw Alder St Ste 520
City
State
Zip
97205-3620
Phone Number
503-418-5311
Fax Number
503-494-4747
person
Provider Business Mailing Address Details
Address
621 Sw Alder St Ste 520
City
State
Zip
97205-3620
Phone Number
503-418-5311
Fax Number
503-494-4747
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
(Oregon)
Definition
Definition to come...
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