Provider Demographics
NPI:1427629567
Name:JARNAGIN, JOSHUA (LMFT INTERN)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:JARNAGIN
Suffix:
Gender:M
Credentials:LMFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3625
Mailing Address - Country:US
Mailing Address - Phone:260-573-9501
Mailing Address - Fax:
Practice Address - Street 1:1305 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3625
Practice Address - Country:US
Practice Address - Phone:126-057-3950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6792101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health