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Jack White, CRM,THW
Peer Specialist in Coos Bay, Oregon
NPI 1407578891

Jack White is a Peer Specialist based in Coos Bay, OR. Jack White practices in Coos Bay, OR and has the professional credentials of CRM,THW. The NPI Number for Jack White is 1407578891 and holds a License No. 22-CRM-1099 (Oregon).

The current practice location address for Jack White is 1741 Newmark Ave, Coos Bay, OR and can be reached out via phone at 541-851-7151.

Location: 1741 Newmark Ave, Coos Bay, OR, 97420-3374
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1407578891
Provider Name
Jack White
Credential
CRM,THW
Provider Entity Type
Individual
Gender
Male
Address
1741 Newmark Ave, Coos Bay, OR, 97420-3374
Phone Number
541-851-7151
Fax Number
Provider Enumeration Date
09/13/2022
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
THW000107022 01 OR THW
institution
Provider Business Practice Location Address Details
Address
1741 Newmark Ave
City
Coos Bay
State
Oregon
Zip
97420-4704
Phone Number
541-851-7151
Fax Number
person
Provider Business Mailing Address Details
Address
1741 Newmark Ave
City
Coos Bay
State
Oregon
Zip
97420-4704
Phone Number
541-851-7151
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
22-CRM-1099 (Oregon)
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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