Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | R6308 | OR |
N | 104100000X | Social Worker |
NPI | 1003311283 |
---|---|
Provider Name | Jordon Richard Lovell |
First Address | Portland, OR 97213-6228 |
Second Address | Portland, OR 97220-5840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2018 |
Last Update Date | 04/12/2020 |