Provider Demographics
NPI:1316774946
Name:ANDERSON, JARREN JAMES TROY
Entity type:Individual
Prefix:MR
First Name:JARREN
Middle Name:JAMES TROY
Last Name:ANDERSON
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 1:11010 SE DIVISION ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-6401
Mailing Address - Country:US
Mailing Address - Phone:971-442-0044
Mailing Address - Fax:971-252-1955
Practice Address - Street 1:21440 SE STARK ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2024
Practice Address - Country:US
Practice Address - Phone:971-703-4623
Practice Address - Fax:971-252-1955
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)