Jae Patricia Douglas | Portland, OR • PECOS Search

Jae Patricia Douglas

Counselor

Behavioral Health & Social Service Providers

9805 NE Shaver St, Portland, OR 97220-3651

PECOS Enrollment

Based on the most recent information from CMS, provider Jae Patricia Douglas does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1881370153
Provider Type
Individual
Full Name
Douglas, Jae Patricia
Title
Dr.
Credential
LMSW, PH.D.

Gender
Female
Sole Proprietor
Yes
Enumeration Date
6/22/2023
Last Updated
6/22/2023

Contact Information

Practice Location

9805 NE Shaver St, Portland, OR 97220-3651

Unlisted Fax

Mailing Location

9805 NE Shaver St, Portland, OR 97220-3651

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License M13927 Oregon