Provider Demographics
NPI:1447719992
Name:ALLEN, JARVIS CRAIG (LCSW)
Entity type:Individual
Prefix:
First Name:JARVIS
Middle Name:CRAIG
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-3400
Mailing Address - Country:US
Mailing Address - Phone:503-808-1256
Mailing Address - Fax:360-737-1424
Practice Address - Street 1:308 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-3400
Practice Address - Country:US
Practice Address - Phone:503-808-1256
Practice Address - Fax:360-737-1424
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical