Individual provider · Type 1 NPI

Jaelithe Azure Formway-Nelson

Mental Health Counselor · Tigard, OR

NPI number 1336679448 Active

Practice location

8915 SW Center St.
Tigard, OR 97223

Call (503) 726-3690 Map

Mailing address

8915 SW Center St
Tigard, OR 97223-6307

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1336679448

Jaelithe Azure Formway-Nelson's National Provider Identifier is 1336679448, issued on Jun 13, 2017. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Tigard, OR. The record was last updated on Jul 21, 2022.