Provider Demographics
NPI:1215789748
Name:MANN, JESSE Z (CFT)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:Z
Last Name:MANN
Suffix:
Gender:U
Credentials:CFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8152 SW HALL BLVD # 1019
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6415
Mailing Address - Country:US
Mailing Address - Phone:917-342-2079
Mailing Address - Fax:
Practice Address - Street 1:4055 SW GARDEN HOME RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3664
Practice Address - Country:US
Practice Address - Phone:503-766-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health