Active NPI
Jaeren Anthony Davis, LICSW, QMHP-C
- Clinical Social Worker
- Vancouver, WA
National Provider Identifier
1386047884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LW61031767
- Practice address
- 400 NE Mother Joseph PL
Vancouver, WA 98664-3200 - Phone
- (360) 256-2000
- Fax
- (360) 514-2548
- NPI assigned
- Sep 29, 2014
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | THW00071 | OR | |
| Clinical Social Worker | 1041C0700X | LW61031767 | WA | Primary |
Addresses
Primary practice location
400 NE Mother Joseph PL
Vancouver, WA 98664-3200
Mailing address
3601 V St
Vancouver, WA 98663-2622
Phone (503) 754-2834
Other practice location 1
33 NW Broadway
Portland, OR 97209-3580
Phone (503) 228-7134
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| THW00071 | OR | MD | Counselor |
| LW61031767 | WA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705449600000",
"number": "1386047884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3601 V ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986632622",
"telephone_number": "503-754-2834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 NE MOTHER JOSEPH PL",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986643200",
"telephone_number": "360-256-2000",
"fax_number": "360-514-2548"
}
],
"practiceLocations": [
{
"address_1": "33 NW Broadway",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972093580",
"country_code": "US",
"telephone_number": "503-228-7134",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DAVIS",
"first_name": "JAEREN",
"middle_name": "ANTHONY",
"credential": "LICSW, QMHP-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-09-29",
"last_updated": "2024-01-17",
"certification_date": "2024-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OR",
"license": "THW00071",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW61031767",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.