Provider Demographics
NPI:1386047884
Name:DAVIS, JAEREN ANTHONY (LICSW, QMHP-C)
Entity type:Individual
Prefix:
First Name:JAEREN
Middle Name:ANTHONY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LICSW, QMHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 V ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2622
Mailing Address - Country:US
Mailing Address - Phone:503-754-2834
Mailing Address - Fax:
Practice Address - Street 1:400 NE MOTHER JOSEPH PL
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3200
Practice Address - Country:US
Practice Address - Phone:360-256-2000
Practice Address - Fax:360-514-2548
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW00071101Y00000X
WALW610317671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor