KEITH ELLIS JACKSON
Counselor (Professional)

Address: 3311 Ne Mlk Blvd, Portland, OR 97212-2086

KEITH ELLIS JACKSON (NPI# 1881289338) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1881289338
Entity Type Individual
Full Name KEITH ELLIS JACKSON
Gender Male
Credential LMFT
Practice Address 3311 Ne Mlk Blvd
Portland
OR 97212-2086
Practice Telephone 5038908074
Mailing Address 8600 Ne 13th Pl
Vancouver
WA 98665-9534
Mailing Telephone 3608528139
Mailing Fax Number 3608528139
Certification Date 2021-03-06
Enumeration Date 2021-03-06
Last Update Date 2021-03-06
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification Group License Number License State Taxonomy Group
Y 101YP2500X Counselor
Specialization: Professional
48284 CA Behavioral Health & Social Service Providers

Associated Endpoints

Endpoint Type Endpoint Affiliation Affiliation Address Use Content
CONNECT URL Vancouver Mind Solutions LLC 3311 Ne Mlk Blvd, Portland, OR 972122086 Health Information Exchange (HIE) CSV

Office Location

Street Address 3311 NE MLK BLVD
City PORTLAND
State OR
Zip Code 97212-2086

Providers in the same location

NPI Name Taxonomy Address Enumeration
1154569382 James Snider Christy Chiropractor 3311 Ne Mlk Blvd Ste 202, Portland, OR 97212-2086 2009-01-26

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1063035293 Candy Lynn Gordon Counselor · Addiction (Substance Use Disorder) 3311 Ne Mlk Jr Blvd Ste 104, Portland, OR 97212-2086 2020-05-21
1356973945 Ailene Joyce Farkac Social Worker 3311 Ne Martin Luther King Jr Blvd Ste 104, Portland, OR 97212-2086 2020-02-11
1033679279 Sherri Warren Massage Therapist 3311 Ne Mlk Jr Blvd, Portland, OR 97212-2086 2019-03-22
1245732544 Walter Irving Chase Rehabilitation Counselor 3311 Ne Martin Luther King Blvd, Portland, OR 97212-2086 2018-03-02
1457894388 Juanita Bradley Peer Specialist 3311 Ne Martin Luther King Jr Blvd, Portland, OR 97212-2086 2016-11-26
1912154352 Alexis-Tran Huyen Nguyen Chiropractor 3311 Ne Mlk Jr Blvd Ste 202, Portland, OR 97212-2086 2008-08-27
1538789656 Wilford Johnson Peer Specialist 3311 Ne Martin Luther King Jr Blvd Ste 104, Portland, OR 97212-2086 2020-04-18
1487282521 Jermaine Christopher Mason Peer Specialist 3311 Ne Martin Luther King Jr Blvd Ste 104, Portland, OR 97212-2086 2020-04-01
1073145777 Lakeesha Dumas Peer Specialist 3311 Ne Mlk Jr Blvd, Portland, OR 97212-2086 2020-02-10
1356906788 Mind Solutions LLC Clinic/Center · Mental Health (Including Community Mental Health Center) 3311 Ne Mlk Jr Blvd, Portland, OR 97212-2086 2019-05-01
Find all providers in zip 97212-2086

Providers in the same zip code prefix

NPI Name Taxonomy Address Enumeration
1205423704 Oregon Cvs Pharmacy LLC · Cvs Pharmacy#11392 Pharmacy · Community/Retail Pharmacy 1821 Ne 33rd Avenue, Portland, OR 97212 2020-12-30
1497223051 Shira Dennis Behavioral Analyst 3424 Ne Tillamook St., Portland, OR 97212 2018-11-12
1659890317 Cidnee Potter Doula 2915 Ne Mlk Jr Blvd, Portland, OR 97212 2017-09-14
1588194187 Ann M Staple Counselor · Mental Health 2905 Ne Tillamook St, Portland, OR 97212 2017-06-15
1780129502 Noelle Denise King Naturopath 2540 Ne Martin Luther King Jr Blvd Femelle Integrative, Suite A, Portland, OR 97212 2017-01-03
1285085100 Jessica Battin Massage Therapist 2310 Ne 8th Ave #2, Portland, OR 97212 2016-06-22
1316311830 Dr Elise Schroeder Clinic/Center 3531 Ne 15th Ave Suite A, Portland, OR 97212 2015-11-20
1467820738 Ayanna Askari Counselor · Addiction (Substance Use Disorder) 3655 N E Grand Ave, Portland, OR 97212 2015-09-03
1053797167 Iliana Henriquez Social Worker · School 3500 Ne Martin Luther King Blvd Suite 200, Portland, OR 97212 2015-07-31
1417346834 Emily Mcdonough Comerford Case Manager/Care Coordinator 1823 Ne 8th Avenue, Kinship House, Portland, OR 97212 2015-01-22
Find all providers in zip 97212

Taxonomy Information

Taxonomy Code 101YP2500X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Professional

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1710565692 Head and Heart Therapy, LLC 1722 Nw Raleigh St Ofc 325, Portland, OR 97209-1753 2021-03-31
1407431703 Deborah Lynn Harrison 1400 Nw 133rd Ave, Portland, OR 97229-4504 2021-03-17
1366036840 Rose City Therapists, LLC 3747 Se Morrison St, Portland, OR 97214-3209 2021-02-24
1518558022 Sara Narayan 1724 Se Mulberry Ave, Portland, OR 97214-4764 2021-01-27
1619567609 Siri Smithback 2016 Ne Highland St, Portland, OR 97211-5323 2021-01-22
1871181933 Rise Holistic Healing, LLC 123 Forest Avenue, Portland, ME 04101-1907 2021-01-05
1881298081 Maximiliano Nealon 1204 Se 51st Ave, Portland, OR 97215-2615 2020-11-28
1811590854 Diana K Oxley 2929 Sw Multnomah Blvd Ste 107, Portland, OR 97219-4070 2020-11-20
1063013373 Ruth Tessema 2120 Ne 166th Dr, Portland, OR 97230-5558 2020-11-03
1568061547 Amanda Marie Bucci 19 South St Ste 6, Portland, ME 04101-3963 2020-10-21
Find all providers in PORTLAND

Competitor

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City PORTLAND
Zip Code 97212

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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