Individual provider · Type 1 NPI

Lashaunda Louise Jackson

Mental Illness Community Based Residential Treatment Facility · Portland, OR

NPI number 1326186271 Active

Practice location

509 NE Alberta St
Portland, OR 97211-3976

Call (503) 249-7767 Map

Mailing address

12942 SE Mitchell St
Portland, OR 97236-4151

Specialties and licenses

TaxonomyCodeLicense
Mental Illness Community Based Residential Treatment Facility Primary 320800000XNone listed
Case Manager/Care Coordinator 171M00000XNone listed

Mental Illness Community Based Residential Treatment Facility: A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

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About NPI 1326186271

Lashaunda Louise Jackson's National Provider Identifier is 1326186271, issued on Feb 2, 2007. The primary taxonomy on file is Mental Illness Community Based Residential Treatment Facility (320800000X), and the practice location is in Portland, OR. The record was last updated on Dec 14, 2009.