Individual provider · Type 1 NPI

Jack S. Bodily

Mental Health Counselor · Portland, OR

NPI number 1982103834 Active

Practice location

17720 NE Halsey St Ste B
Portland, OR 97230-6771

Call (503) 654-7654 Map

Fax (503) 654-7333

Mailing address

3587 Heathrow Way
Medford, OR 97504-4004

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

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About NPI 1982103834

Jack S. Bodily's National Provider Identifier is 1982103834, issued on Feb 6, 2018. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Portland, OR. The record was last updated on Feb 6, 2018.