Provider Demographics
NPI:1962558361
Name:FARRIS, JASON MANON (LPC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:MANON
Last Name:FARRIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6773
Mailing Address - Country:US
Mailing Address - Phone:541-690-8452
Mailing Address - Fax:
Practice Address - Street 1:810 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6773
Practice Address - Country:US
Practice Address - Phone:541-690-8452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4762101YP2500X
GALPC004760101YP2500X
CA977101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional