Clark, Jayson

Clark, Jayson is an individual health care provider with primary practice located at 621 W Madrone St , Roseburg OR 97470. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is his primary health care specialty. Clark, Jayson can be contacted via phone (541) 672-2691.

Contact Information

Primary practice address
621 W Madrone St Roseburg OR 97470
Phone: (541) 672-2691
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X T-17-081 Oregon
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Behavioral Health & Social Service Providers / Professional 101YP2500X C5596 Oregon

Profile Details

NPI number 1598198954
LBN Legal business name Clark, Jayson
Credentials MSMFT, LPC
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 20th, 2013
Last updated Jul 7th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598198954 NPPES
Oregon MEDICAID 500725582
Oregon MEDICAID 500714629

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