Provider Demographics
NPI:1194114389
Name:CORBETT, JANA MARIE (BSC, MSC, PHD)
Entity type:Individual
Prefix:DR
First Name:JANA
Middle Name:MARIE
Last Name:CORBETT
Suffix:
Gender:F
Credentials:BSC, MSC, PHD
Other - Prefix:DR
Other - First Name:JANA
Other - Middle Name:
Other - Last Name:RICHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSC, MSC, PHD
Mailing Address - Street 1:9620 NW BERMAR LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5218
Mailing Address - Country:US
Mailing Address - Phone:714-018-2939
Mailing Address - Fax:
Practice Address - Street 1:9620 NW BERMAR LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5218
Practice Address - Country:US
Practice Address - Phone:971-401-8293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18-02-05101YA0400X
OR2811103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500704276Medicaid