Provider Demographics
NPI:1902251333
Name:JAROSS, PATRICK WM (PEER SUPPORT SPECIAL)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:WM
Last Name:JAROSS
Suffix:
Gender:M
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SW BEACH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:DEPOE BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97341-9677
Mailing Address - Country:US
Mailing Address - Phone:541-265-0505
Mailing Address - Fax:541-265-0601
Practice Address - Street 1:51 SW LEE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3823
Practice Address - Country:US
Practice Address - Phone:541-574-5960
Practice Address - Fax:541-574-6252
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health