Jason David Wallis, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C7443 Issued in OR

Practice address

2901 E Burnside St
Portland, OR 97214-1831

Phone

(503) 953-0310

NPI assigned

Feb 12, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brightways Counseling Group LLC

  • Group Psychotherapy Psychologist
  • Redmond, OR
  • NPI 1689191165
  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1184786527

  Counselor

  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1649722034
  NPD
• Kaiser Foundation Health Plan of the Northwest

  • Clinic/Center
  • Hillsboro, OR
  • NPI 1942718622
  NPD
• Bright Horizons Psychiatric Group LLC

  • Child & Adolescent Psychiatric/Mental Health Registered Nurse
  • Redmond, OR
  • NPI 1629724695
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1396913331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 NE MARTIN LUTHER KING JR BLVD STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972122093",
            "telephone_number": "503-655-8264",
            "fax_number": "503-953-2454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141831",
            "telephone_number": "503-953-0310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3500 NE Martin Luther King Jr Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972122093",
            "country_code": "US",
            "telephone_number": "503-496-3201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "JASON",
        "middle_name": "DAVID",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-12",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C7443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Jane Waller, CRNFA
• Tracie Walliker, LMT
• Megan E Wallin, QMHA-I
• Grace Bailey Wallingford, RD
• Anne Wallis, RN
• Jennifer Wallis, LCSW, CADCIII
• Jordann Wallis, MS, CGC
• Justene Emma Wallis
• Scott Wallis, RPH
• Tami Wallis

• Professional Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.