Jae Patricia Douglas, LMSW, PH.D.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

M13927 Issued in OR

Practice address

9805 NE Shaver St
Portland, OR 97220-3651

Phone

(503) 860-7589

NPI assigned

Jun 22, 2023

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1687392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1881370153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9805 NE SHAVER ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972203651",
            "telephone_number": "503-860-7589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9805 NE SHAVER ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972203651",
            "telephone_number": "503-860-7589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "JAE",
        "middle_name": "PATRICIA",
        "name_prefix": "Dr.",
        "credential": "LMSW, PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-22",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "M13927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chloe Elise Douglas, MD
• Daniel Ray Douglas, M.D.
• David Morrison Douglas, MD
• Edmond Arlen Douglas
• Emelie Angelina Douglas, MA, LPC
• Kaitlyn Douglas, LMT
• Mackenzie E Douglas, D.M.D.
• Peter Douglas, DDS
• Savanna Douglas
• Shannon B Douglas, RN

• Mental Health Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.