Provider Demographics
NPI:1215706742
Name:CHAPMAN, JESSE JAMES (QMHA-R)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:JAMES
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:QMHA-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 SE 82ND AVE STE O
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7641
Mailing Address - Country:US
Mailing Address - Phone:503-722-6216
Mailing Address - Fax:
Practice Address - Street 1:11211 SE 82ND AVE STE O
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7641
Practice Address - Country:US
Practice Address - Phone:503-722-6216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health