1174150536 NPI number — MRS. JESSICA ANN LUVSHIS MAS-MFT, QMHP

Table of content: MRS. JESSICA ANN LUVSHIS MAS-MFT, QMHP (NPI 1174150536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174150536 NPI number — MRS. JESSICA ANN LUVSHIS MAS-MFT, QMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUVSHIS
Provider First Name:
JESSICA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MAS-MFT, QMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHNUR
Provider Other First Name:
JESSICA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174150536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 JEFFERSON PARKWAY
Provider Second Line Business Mailing Address:
APT. F10
Provider Business Mailing Address City Name:
LAKE OSWEGO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-732-5750
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
424 NE 22ND AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97232-2809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-202-8060
Provider Business Practice Location Address Fax Number:
503-408-5201
Provider Enumeration Date:
03/25/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 20-QMHP-R-0209 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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