Individual provider · Type 1 NPI

Jettison Earthworm Tenacity

Mental Health Counselor · Portland, OR

NPI number 1174438519 Active

Practice location

5331 S Macadam Ave Ste 287
Portland, OR 97239-3849

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

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About NPI 1174438519

Jettison Earthworm Tenacity's National Provider Identifier is 1174438519, issued on Aug 18, 2026. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Portland, OR. The record was last updated on Aug 18, 2026.