Provider Demographics
NPI:1285488700
Name:CETZ, JESSE
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:CETZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 SW GREENBURG RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5502
Mailing Address - Country:US
Mailing Address - Phone:503-486-3439
Mailing Address - Fax:
Practice Address - Street 1:9900 SW GREENBURG RD STE 200
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5502
Practice Address - Country:US
Practice Address - Phone:971-266-4759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional