Provider Demographics
NPI:1851176903
Name:GRAFTON, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:GRAFTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOEY
Other - Middle Name:
Other - Last Name:GRAFTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3334 SE HAWTHORNE BLVD APT 302
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5060
Mailing Address - Country:US
Mailing Address - Phone:916-225-1257
Mailing Address - Fax:
Practice Address - Street 1:6400 SE LAKE RD STE 250
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222-2129
Practice Address - Country:US
Practice Address - Phone:541-900-4285
Practice Address - Fax:888-810-2993
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORR10521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program