MR. JACK DOUGLAS KELLEY L.P.C. NPI 1265873343

NPI Information

NPI: 1265873343
Provider Name: MR. JACK DOUGLAS KELLEY, L.P.C.
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

Address:
1027 E BURNSIDE ST
PORTLAND, OR
ZIP 97214
Phone: (503) 239-8400
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MR. Jack Douglas Kelley, L.P.C. is a mental health counselor in Portland, OR. MR. Jack Douglas Kelley, L.P.C. NPI is 1265873343. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1027 E BURNSIDE ST
PORTLAND, OR
ZIP 97214-328
Phone: (503) 239-8400
Fax: (503) 239-8406

The enumeration date for this NPI number is 7/17/2013 and was last updated on 12/17/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	C3282	OREGON	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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