Active NPI
Anthony Dion Jarrard, PSS/QMHAI
- Peer Specialist
- Gresham, OR
National Provider Identifier
1235785502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 3210
- Practice address
- 620 NE 2ND St
Gresham, OR 97030-7514 - Phone
- (503) 224-1044
- NPI assigned
- Aug 13, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 3210 | OR | Primary |
| Mental Health Counselor | 101YM0800X | 25-QMHA-I-005159 | OR |
Addresses
Primary practice location
620 NE 2ND St
Gresham, OR 97030-7514
Mailing address
211 SE Caruthers St
Portland, OR 97214-4502
Phone (503) 224-1044
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500768570 | Medicaid | OR | |
| 500770905 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18-CRM-206 | OR | MD | Addiction (Substance Use Disorder) Counselor |
| 25-QMHA-I-005159 | OR | MD | Mental Health Counselor |
| 3210 | OR | MD | Forensic Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786924800000",
"number": "1235785502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 SE CARUTHERS ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972144502",
"telephone_number": "503-224-1044",
"fax_number": "971-260-0355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 NE 2ND ST",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970307514",
"telephone_number": "503-224-1044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JARRARD",
"first_name": "ANTHONY",
"middle_name": "DION",
"credential": "PSS/QMHAI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-13",
"last_updated": "2026-08-17",
"certification_date": "2026-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "3210",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "25-QMHA-I-005159",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500768570",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500770905",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.