Provider Demographics
NPI:1588345557
Name:SELF, JOSIE MARIE (MA)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:MARIE
Last Name:SELF
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NE STUCKI AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7328
Mailing Address - Country:US
Mailing Address - Phone:360-230-7790
Mailing Address - Fax:
Practice Address - Street 1:3000 NE STUCKI AVE STE 230
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7328
Practice Address - Country:US
Practice Address - Phone:360-230-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR8423101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health